Early and Late Anatomical and Functional Comparison of Temporal Mus-cle Fascia and Conchal Cartilage Usage as Myringoplasty Graft Material
Abstract
Aim: We aimed to compare the early and long-term anatomic and functional results of temporalis muscle fascia (TMF) and conchal cartilage (CC) grafts in myringoplasty operations for the repair of subtotal tympanic membrane perforations.
Materials and Methods: A total of 110 myringoplasty patients who were operated between April 2016 and April 2018 were included in the study. Age, gender, graft material (TMF/CC), preoperative and postoperative hearing levels, graft success and functional success (air-bone gap <10 dB) were recorded for each patient.
Results: There was no significant difference between the TMF (93.5%) and CC (93.8%) groups in terms of early graft success. (p = 0.966). There was no significant difference between the TMF (85.5%) and CC (91.7%) groups in terms of long-term graft success. (p = 0.319). There was no significant difference between TMF (87.1%) and CC (85.4%) groups in terms of early functional success. (p = 0.799). There was no significant difference between the TMF (82.3%) and CC (83.3%) groups in terms of long-term functional success. (p = 0.882).
Conclusion: The results of our study showed that TMF and CC grafts had similar success rates in the early period. Concha cartilage can be preferred in primary myrin-goplasties due to the high rate of late graft success and no negative effect on hearing.
References
- 1. Rizer FM. Overlay versus underlay tympanoplasty. Part 1: Historical review of the literature. Laryngoscope. 1997;107(84):26-36. DOI: 10.1097/00005537-199712001-00002. 2. Wullstein HL. Functional operations in the middle ear with split-thickness skin graft. Arch Otorhinolaryngol. 1953;161:422-35. DOI: 10.1007/BF02129204.
- 3. Zoellner F. The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol. 1955; 69(10):567-9. DOI: 10.1017/S0022215100051240.
- 4. Caye´-Thomasen P, Andersen J, Uzun C, Hansen S, Tos M. Ten-year results of cartilage palisades versus fascia in eardrum reconstruction after surgery for sinus or tensa retraction cholesteatoma in children. Laryngoscope. 2009; 119(5):944–52. DOI: 10.1002/lary.20195.
- 5. Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multivariate analysis of otological, surgical and patient related factors in determining success in myringoplasty. Clin Otolaryngol. 2005; 30:115–20. DOI: 10.1111/j.1365-2273.2004.00947.x.
- 6. Uguz MZ, Onal K, Kazikdas KC, Onal A. The influence of smoking on success of tympanoplasty measured by serum cotinine analysis. Eur Arch Otorhinolaryngol. 2008; 265(5): 513-16. DOI: 10.1007/s00405-007-0485-8.
- 7. Mürbe D, Zahnert T, Bornitz M, Hüttenbrink KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope. 2002; 112(10): 1769-76. DOI: 10.1097/00005537-200210000-00012.
- 8. Adkins WY. Composite autograft for tympanoplasty and tympanomastoid surgery. Laryngoscope. 1990;100(3):244–7. DOI: 10.1288/00005537-199003000-00007.
- 9. Boedts D. Tympanic grafting materials. Acta Otorhinolaryngol Belg. 1995; 149(2): 193–99. PMID: 7610913.
- 10. Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg. 2008; 139(3): 386-90. DOI: 10.1016/j.otohns.2008.05.623.
- 11. Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E, Can N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. EurArch Otorhinolaryngol. 2011; 268(3): 471-74. DOI: 10.1007/s00405-010-1473-y.
- 12. Kum RO, Ulusal T, Gungor V, Altuntas MO, Yilmaz YF, Ozcan M et al. Comparison of cartilage and fascia graft in type I tympanoplasty:our early result. KBB-Forum: Elektronik Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi. 2016;15(2).
- 13. Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope. 2000; 110(12): 1994-99. DOI: 10.1097/00005537-200012000-00002.
- 14. Ozbek C, Ciftci O, Tuna EEU, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol. 2008; 29(5): 679-83. DOI: 10.1097/MAO.0b013e31817dad57.
- 15. Guler I, Baklaci D, Kuzucu I, Kum RO, Ozcan M. Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients. Auris Nasus Larynx, 2019; 46(3): 319-23. DOI: 10.1016/anl.2018.09.003
- 16. Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R. Comparison of cartilage with temporalis fascia tympanoplasty: A meta‐analysis of comparative studies. Laryngoscope. 2017; 127(9): 2139-48. DOI: 10.1002/lary.26451.
- 17. Yetiser S, Hidir Y. Temporalis fascia and cartilage-perichondrium composite shield grafts for reconstruction of the tympanic membrane. Ann Otol Rhinol Laryngol. 2009; 118(8): 570-74. DOI: 10.1177/000348940911800807
Miringoplastide Greft Materyali Olarak Temporal Kas Fasyası ve Konkal Kıkırdak Kullanımının Erken ve Geç Dönem Anatomik ve Fonksiyonel Karşılaştırılması
Abstract
Amaç: Timpanik membran perforasyonlarının onarımı için uygulanan miringoplasti ameliyatlarında temporal kas fasyası (TKF) ve konkal kıkırdak (KK) greftlerinin erken ve geç dönem anatomik ve fonksiyonel sonuçları karşılaştırıldı.
Gereç ve Yöntemler: Çalışmaya kliniğimizde Nisan 2016 - Nisan 2018 tarihleri arasında opere edilen toplam 110 miringoplasti hastası dahil edildi. Her hasta için yaş, cinsiyet, greft materyali (TKF/KK), preoperatif ve postoperatif işitme seviyeleri, greft başarısı ve fonksiyonel başarı (hava-kemik aralığı < 10 dB) kaydedildi .
Bulgular: Erken dönem greft başarısı açısından TFK (%93.5) ve KK (%93.8) grupları arasında anlamlı bir fark yoktu. (p= 0.966). Geç dönem greft başarısı açısından TFK (%85.5) ve KK (%91.7) grupları arasında anlamlı bir fark yoktu. (p= 0.319). Erken dönem fonksiyonel başarı açısından TFK (%87.1) ve KK (%85.4) grupları arasın-da anlamlı bir fark yoktu. (p= 0.799). Geç dönem fonksiyonel başarı açısından TFK (%82.3) ve KK (%83.3) grupları arasında anlamlı bir fark yoktu. (p= 0.882).
Sonuç: Çalışmamızın sonucu TKF ve KK greftlerinin erken dönemde benzer başarı oranlarına sahip olduğunu gösterdi. Konkal kartilaj, geç dönem greft başarı oranının yüksek olması ve işitme üzerinde olumsuz bir etkisi olmaması nedeniyle primer mir-ingoplastide güvenle tercih edilebilir.
References
- 1. Rizer FM. Overlay versus underlay tympanoplasty. Part 1: Historical review of the literature. Laryngoscope. 1997;107(84):26-36. DOI: 10.1097/00005537-199712001-00002. 2. Wullstein HL. Functional operations in the middle ear with split-thickness skin graft. Arch Otorhinolaryngol. 1953;161:422-35. DOI: 10.1007/BF02129204.
- 3. Zoellner F. The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol. 1955; 69(10):567-9. DOI: 10.1017/S0022215100051240.
- 4. Caye´-Thomasen P, Andersen J, Uzun C, Hansen S, Tos M. Ten-year results of cartilage palisades versus fascia in eardrum reconstruction after surgery for sinus or tensa retraction cholesteatoma in children. Laryngoscope. 2009; 119(5):944–52. DOI: 10.1002/lary.20195.
- 5. Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multivariate analysis of otological, surgical and patient related factors in determining success in myringoplasty. Clin Otolaryngol. 2005; 30:115–20. DOI: 10.1111/j.1365-2273.2004.00947.x.
- 6. Uguz MZ, Onal K, Kazikdas KC, Onal A. The influence of smoking on success of tympanoplasty measured by serum cotinine analysis. Eur Arch Otorhinolaryngol. 2008; 265(5): 513-16. DOI: 10.1007/s00405-007-0485-8.
- 7. Mürbe D, Zahnert T, Bornitz M, Hüttenbrink KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope. 2002; 112(10): 1769-76. DOI: 10.1097/00005537-200210000-00012.
- 8. Adkins WY. Composite autograft for tympanoplasty and tympanomastoid surgery. Laryngoscope. 1990;100(3):244–7. DOI: 10.1288/00005537-199003000-00007.
- 9. Boedts D. Tympanic grafting materials. Acta Otorhinolaryngol Belg. 1995; 149(2): 193–99. PMID: 7610913.
- 10. Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg. 2008; 139(3): 386-90. DOI: 10.1016/j.otohns.2008.05.623.
- 11. Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E, Can N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. EurArch Otorhinolaryngol. 2011; 268(3): 471-74. DOI: 10.1007/s00405-010-1473-y.
- 12. Kum RO, Ulusal T, Gungor V, Altuntas MO, Yilmaz YF, Ozcan M et al. Comparison of cartilage and fascia graft in type I tympanoplasty:our early result. KBB-Forum: Elektronik Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi. 2016;15(2).
- 13. Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope. 2000; 110(12): 1994-99. DOI: 10.1097/00005537-200012000-00002.
- 14. Ozbek C, Ciftci O, Tuna EEU, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol. 2008; 29(5): 679-83. DOI: 10.1097/MAO.0b013e31817dad57.
- 15. Guler I, Baklaci D, Kuzucu I, Kum RO, Ozcan M. Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients. Auris Nasus Larynx, 2019; 46(3): 319-23. DOI: 10.1016/anl.2018.09.003
- 16. Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R. Comparison of cartilage with temporalis fascia tympanoplasty: A meta‐analysis of comparative studies. Laryngoscope. 2017; 127(9): 2139-48. DOI: 10.1002/lary.26451.
- 17. Yetiser S, Hidir Y. Temporalis fascia and cartilage-perichondrium composite shield grafts for reconstruction of the tympanic membrane. Ann Otol Rhinol Laryngol. 2009; 118(8): 570-74. DOI: 10.1177/000348940911800807
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Article |
| Authors | |
| Publication Date | October 26, 2019 |
| Submission Date | April 30, 2019 |
| Acceptance Date | August 31, 2019 |
| Published in Issue | Year 2019 Volume: 3 Issue: 3 |
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