Tympanic membrane was carefully dissected from handle of malleus
Here in 62 cases the graft was placed medial to the handle of malleus
(Underlay Technique) and in 62 cases the graft was placed lateral to the handle of malleus
of but medial to the remnant of tympanic membrane.
The tympano-meatal flap is freed from the handle of malleus
by sharp dissection of the middle ear mucosa with sickle knife.
The entire flap is now pushed forwards, and separated from the handle of malleus and its lateral process, along with the pars flaccida.
However in our series, 1 was seen in the pars flaccid area, another one in the region of umbo, may be because of insufficient removal of residual squamous epithelium from the handle of malleus.
In underlay grafting, graft was put lateral to handle of malleus
by elevating the tympanomeatal flap.
Proper placing of the graft medial to the handle of malleus
will avoid the lateralization.
In patients with erosion of handle of malleus
and the long process of incus, the average hearing loss was 39.