Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction

Since Utech's introduction of cartilage as a columella in ear surgery in 1969, we have used tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall in 13,000 cases. As large pieces of cartilage can twist in later years, we place palisaded cartilage fragments with perichondrium parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus (and malleus), crossing the promontory and reducing adhesions. A "tunnelplasty" keeps the eustachian tube entrance open with the semiring of cartilage ("simmering") apposed to the inside of the annulus, reconstructing the tympanomeatal niche. The "architrave" created rests on the tensor tympani while the palisaded epitympanum and antrum plasty allows ventilation of the antrum. Mastoid obliteration is performed with an autogenous perichondrial transplant to which the palisaded incised cartilage portions adhere, adapting to the underlying structure.