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[Tympanic grafts: surgical techniques and results of 260 cases]
E Rondini-Gilli1, I Mosnier, J M Gouin
1Service ORL, Hôpital Beaujon, AP-HP, Faculté Xavier Bichat, Université Paris VII, 100 bd du général Leclerc, 92110 Clichy, France.
Purpose Of Study:
The aim of this retrospective survey was to define factors which may influence tympanic grafts results.
Methods:
260 surgical procedures were retrospectively analyzed between 1992 and 1997 by studying anatomical and functional results with a mean follow-up of 18 months.
Results:
Global rate of tympanic grafts reperforation was 9.2%. At 18 months, the air conduction gain was 9.5 +/- 11.5 dB, with an 13 +/- 7.7 dB air-bone gap (ABG) and 80% ABG inferior to 20 dB, the change in air bone gap was 9 +/- 10.3 dB. Several factors influencing the results were identified: second hand surgical procedures (40%) had worse functional results than patients from first hand procedures, inflammatory atrial mucosa or obstruction of the eustachian tube (more graft retraction), retracted malleus handle and/or stuck to the promontory (worse auditory results), temporal aponeurosis placed under malleus handle (more reperforation of the graft without hearing difference as to graft placement above malleus handle), association of canal wall-down technique (poor auditory results), surgeon experience (better auditory results).
Conclusion:
A first surgical procedure, normal malleus handle and atrial mucosa, no mastoidectomy or canal wall-up technique, a temporal aponeurosis graft placed above malleus handle are predictive factors for anatomical and/or functional good results.