Cartilage Tympanoplasty: Classification of Methods -- Techniques -- Results

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Contents

  1. Сведения о продавце
  2. Customers who bought this item also bought
  3. Cartilage Tympanoplasty
  4. Butterfly Cartilage Tympanoplasty

Patients were excluded from the study if they had any of the following: Preoperatively, patients underwent routine investigations including tuning fork tests, Hb, bleeding time, clotting time, complete urine examination and if necessary lateral view X-ray. All patients were operated under local anesthesia using xylocaine. Pure-tone audiometry was performed in each case and the average air bone gap of each patient was calculated preoperatively and postoperatively at the frequency of , and Hz.

The purpose audiometric testing was also to ascertain the cochlear function reserve of the patient. All patients fasted at least six hours before surgery and consent was taken in writing. Premedication with pentazocin 30 mg, promethazine 25 mg and atropine 0. The operated area was cleaned with betadine and methylated spirit and draped ensuring complete asepsis. An incision in the skin was made 2 mm away from the lateral edge of the tragus Figure 1.

Tragal cartilage was exposed and an incision was made on the cartilage on the medial side 2 mm away from the cartilage summit so that a small strip of cartilage was left in place to maintain tragal contour postoperatively. The surfaces and the wound were sutured with silk, which was removed after 7 days. The cartilage graft was tailored according to the size of the perforation, i.


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  • Classification of Methods - Techniques - Results.

The cartilage graft was held with a gloved thumb and index finger and carefully grooved all along its perimeter using surgical blade no. Extreme care was taken to avoid peeling off the perichondrium Figure 3. The margins of perforation were freshened and the cartilage graft was slipped across the perforation one edge of the cartilage at a time, as if a cuff link was being inserted across a button hole. Initially the butterfly cartilage perichondrium graft was placed anteriorly and inferiorly.

The margins of the perforation usually went inside the groove to about 1 to 2 mm depth and the plugged cartilage formed an island, as one surface of cartilage with its perichrondrium lies inside the middle ear and other on the lateral side of the margin of the perforation. The canal was packed with medicated gelfoam and a sterile cottonball was put in the external meatal opening.

The patient was discharged on the same day. At one week follow up, suture removal was done and the operated tympanic membrane was inspected and patient was called after 4, 6, and 12 weeks for follow up Figure 4.

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The graft was considered successful if the tympanic membrane was found intact at 6 weeks and pure tone averages were also obtained at the same time. Out of the total patients, Out of 21 male patients, we had success in 20, i. The size of the perforation was 2, 3, 4 and 5 mm in 4, 18, 10 and 8 numbers of patients, respectively. The maximal closure rate was observed in 3 mm perforations; however, the healing was almost the same in the rest of the perforation.

Twenty-three patients had an air bone gap in the range of , 9 patients 21 to 30 dB and 8 patients showed an air bone gap of greater than 30 dB, preoperatively whereas no patient had an air bone gap below 10 dB prior to surgery. Postoperatively, at six weeks, 8 patients had an air bone gap below 10 dB, whereas 28 patients improved below 20 dB and 4 cases remained at the same level as preoperative Table 2. Two cases had graft acceptance initially but after 2 weeks had recurrence of perforation and extrusion of cartilage graft due to otomycosis.

Comparisons of pre and postoperative air bone gap on pure tone audiometry. Chronic suppurative otitis media is a very common condition in the practice of otolaryngology both in developed as well as developing countries. The common sequel of chronic suppurative otitis media is perforation of the tympanic membrane which results in recurrent otorrhea and hearing loss.

Every otolaryngologist must know how to repair a tympanic membrane perforation. A commonly used graft is the temporalis fascia which may be used in an underlay or onlay technique. In current surgical practice, the tragal cartlage with perichondrium graft has gained popularity, more so after the technique was described by Eavey. The cartilage tympanoplasty offers an otologist another reliable material in his armamentarium for tympanic membrane reconstruction. The choice of technique largely depends on the surgeon's preference. Eavey 4 first used tragal cartilage with perichondrium on both sides for myringoplasty for small tympanic membrane perforation in children.

The logic for this technique was that since the children have repeated upper respiratory infections, and the cartilage graft type I tympanoplasy will resist reperforations subsequent to these infections. He also placed a split thickness skin graft on the cartilage. However, in our patients we used neither skin or any other graft over the cartilage.

Cartilage tympanoplasty has many advantages in situations such as recurrent, residual, total perforations, chronic mucosal dysfunction or severely atelectatic tympanic membranes, where facia and perichondrium undergo atrophy and subsequent failure. Further, it has a low metabolic rate to survive long and is well accepted in the middle ear.

Сведения о продавце

However, cartilage has been criticized due to concern regarding hearing results because of its thickness. The results were comparable to temporalis fascia. They advocated that a cartilage perichondrium graft is useful to prevent recurrence or progression of postoperative retraction pockets. Recent studies by Mohamad, et al. Group A the tympanic membrane is repaired using many full thickness strips of cartilage with perichondrium on canal side.

Six different methods are included in this group. Group B consists of cartilage tympanoplasty with several foils, thin and thick plates of bare cartilage without perichondrium. Four different methods are included in this group. Group C consists of a cartilage perichondrium composite island graft where perichondrium suspends and fixates the cartilage island.

In this group also four different methods are included.

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Group D, a total pars tensa perforation is reconstructed using a large cartilage perchondrium graft. There different methods of reconstruction were used in this group. Group E, anterior, inferior and subtotal perforations were repaired using a cartilage perichondrium composite graft. In this group, four methods were used including two inlay and two onlay techniques. Group F, the cartilage disc is placed under the perforation and perichondrium on top of the tympanic membrane on the denuded margins of perforation.

Butterfly cartilage tympanoplasty is included in this group. We performed cartilage tympanoplasty in healthy young patients.

Cartilage Tympanoplasty

Only smoking was found to have an adverse effect on graft uptake. They specially recommended butterfly cartilage tympanoplasty in older patients or who had no other comorbidities. Results of cartilage tympanoplasty, even in large perforations, was found to be good. Cartilage tympanoplasty is described to be of utmost value in large size perforations which include revision surgery, anterior, marginal or even a draining perforation at the time of surgery, subtotal or total perforation and bilateral perforation.

The cartilage thickness of the tragus and cymba is the same in children as in adults, however, the perichondrium is more adherent in children. Hence while making a groove or if the perichondrium is to be removed from one side, one must be careful while making a butterfly cartilage graft in children. Cartilage should be held between the finger and thumb and not in tooth forceps to avoid breakage.

Tragal cartilage is ideal since it is thin flat and in a reasonable quantity to reconstruct even the entire tympanic membrane Dornhoffer. Each section is essentially self-contained Read more Read less. Customers who bought this item also bought. Page 1 of 1 Start over Page 1 of 1. Tympanoplasty, Mastoidectomy, and Stapes Surgery. Start reading Cartilage Tympanoplasty on your Kindle in under a minute.

Cartilage Tympanoplasty Classification of Methods Techniques Results

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Butterfly Cartilage Tympanoplasty

Write a customer review. Most helpful customer reviews on Amazon. It is a unique gathering of all categories of cartilage tympanoplasty with a novel classification.