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Inlay butterfly cartilage tympanoplasty in children
Vincent Couloigner1, Florence Baculard, Wissame El Bakkouri
1Department of Pediatric Otolaryngology and Head and Neck Surgery, Hôpital Robert Debré, AP-HP, Paris, France. vincent.couloigner@rbh.ap-hop-paris.fr
Insights
Inlay butterfly cartilage tympanoplasty is a safe and effective surgical technique for children with tympanic membrane perforations. This method offers good hearing outcomes and is technically straightforward, making it a valuable option for pediatric ear surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Techniques
Background:
- Tympanic membrane perforations are common in children.
- Cartilage tympanoplasty offers an alternative to traditional graft materials.
- The inlay butterfly technique is a specific method for cartilage grafting.
Purpose of the Study:
- To evaluate the efficacy and outcomes of inlay butterfly cartilage tympanoplasty in pediatric patients.
- To compare the results of this technique with underlay fascia temporalis myringoplasty.
Main Methods:
- A before-and-after trial was conducted with 59 pediatric cases.
- Inlay butterfly cartilage tympanoplasty was performed without a split-thickness skin graft.
- Outcomes measured included perforation closure rates, complications, and hearing thresholds.
Main Results:
- The inlay butterfly cartilage tympanoplasty achieved a 71% closure rate, comparable to underlay fascia temporalis tympanoplasty (83%).
- Graft success improved when the graft was at least 2 mm larger than the perforation (81% success).
- Hearing thresholds improved postoperatively, with no significant difference compared to the underlay technique.
Conclusions:
- Inlay butterfly cartilage tympanoplasty is a safe, efficient, and easy surgical option for children.
- The technique demonstrates good anatomical and audiological results.
- Optimizing graft size and potentially using a split-thickness skin graft can further enhance outcomes.
Objective:
To assess the results of inlay butterfly cartilage tympanoplasty in children.
Study Design:
Before-and-after trial; follow-up duration, 26.6 +/- 19.9 months (mean +/- standard deviation).
Setting:
Tertiary referral center.
Patients:
Fifty-nine pediatric cases of tympanic membrane perforation.
Intervention:
Inlay butterfly cartilage tympanoplasty was performed under general anesthesia according to the technique originally described by Eavey and modified by Lubianca-Neto (i.e., without any associated split-thickness skin graft).
Main Outcome Measures:
Percentage of perforation closures, surgical complications, preoperative and postoperative puretone hearing thresholds; the results of inlay butterfly cartilage tympanoplasty were compared with those obtained in a retrospective series of 29 underlay fascia temporalis myringoplasties.
Results:
The 71% "take rate" of inlay butterfly cartilage tympanoplasty was not significantly different from the 83% take rate obtained with underlay fascia temporalis tympanoplasty (p = 0.23, chi test). The anatomic results were improved when the graft diameter was at least 2 mm larger than the size of the perforation (81% take rate) (p = 0.009, chi test). No iatrogenic cholesteatoma was observed. Pure-tone hearing thresholds were improved at 0.5, 1, and 2 kHz, and stable at 4 kHz. Hearing levels were not different from those obtained with underlay fascia temporalis tympanoplasty.
Conclusion:
Inlay butterfly cartilage tympanoplasty is a safe, efficient, time-saving, and easy technique of tympanoplasty in children. Anatomic results may be improved by associating a split-thickness skin graft and/or by trimming a tragal graft much larger than the size of the perforation.
