Article
Tear In the Tympanomeatal Flap in Tympanoplasty – Does it matter?
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Authors
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Asrar Ahmed Latifi
- Buraidah Central Hospital, ENT-Dept, Buraidah, AlQassim, Königreich Saudi Arabien
| Published: | April 22, 2010 |
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Outline
Text
Wullstein and Zollner introduced the concept of tymanoplasty but Maurice Sourdille innovated the use of tympanomeatal flap in the field of chronic ear diseases. Since then tympanomeatal flaps have been useful for number of purposes in otologic surgery.
Tears in the tympanomeatal flap can occur as linear, buttonhole or separation of flap from the annulus when difficulty is encountered in elevation of the annulus. Most commonly tears occur in the hand of inexperienced otologic surgeons but can also occur in experienced hands.
Sixty (60) cases of type I tympanoplasty by the underlay technique were studied prospectively during a period of 18 months. (tympanomeatal flap elevation is essential in placing the graft ). Fourteen (14) cases had tear in the tympanomeatal flap. Six (6) of these had small tears like linear or button holes which did not need any repair. Eight (8) cases had large tears, that were repaired by the help of temporalis fascia graft covering the perforation as well as the tear in the tympanomeatal flap. Care must be taken to avoid unfolding of the margins of the tear while replacing the flap.
Our message with this paper, mainly to the learners and inexperienced ear surgeons is that: A torn tympanomeatal flap does not need abandoning the procedure; it can be repaired by approximaton or with the help of temporalis fascia graft placement over the bare area of the bony canal.
Review of literature shows that experience in such problems has not been highlighted.
