After putting antibiotic steroid-soaked gel foam in the middle ear, the graft is placed medial to the handle of malleus
and carefully placed below the perforation.
The middle ear was filled with gelfoam and then the graft was fixed under the anterior annular flap and the posterior tympanomeatal flap, and it is placed medial to the handle of malleus. After that the external auditory canal filled with gelfoam.
In Cartilage Tympanoplasty technique, the cartilage was sliced into a thickness of 0.4 mm with a slicer and was fixed under the freshened edges of perforation and medial to the handle of malleus after filling the middle ear with gelfoam.
The malleus was intact in 69 (67.6%) patients, handle of malleus was eroded in 21 (20.6%) patients and complete erosion of malleus was seen in 12 (11.8%) patients.
Details of Ossicular Chain Erosion Malleus Intact 69 67.6% Handle of malleus erosion 21 20.6% Complete erosion of malleus 12 11.8% 102 100 Incus Intact 6 5.9% Erosion of lenticular process 3 2.9% Erosion of long process 81 79.4% Erosion of body 12 11.8% 102 100 Stapes Suprastructure intact 54 52.9% Suprastructure eroded 48 47.1% 102 100 Table 3.
Tympanic membrane was carefully dissected from handle of malleus
. Now tympanomeatal flap was positioned anteriorly on the anterior meatal wall.
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 graft was placed medial to the handle of malleus
. Gelfoam was placed along the remnant of tympanic membrane and the graft.
Freeing the tympano-meatal flap from the handle of malleus
. 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.
In underlay grafting, graft was put lateral to handle of malleus
by elevating the tympanomeatal flap.
In patients with erosion of handle of malleus
and the long process of incus, the average hearing loss was 39.38+/-5.15 dB.