A method for ossicular reconstruction with tragal cartilage autografts

Reconstruction of the ossicular mechanism using a tragal cartilage autograft frequently presents problems, including displacement of the cartilage graft, maintenance of firm and accurate contact between the graft and ossicular remnants, and loss of stiffness of the graft. To avoid these problems, we have used the cartilage graft and overlying perichondrium of appropriate size, with a tunnel made between the outer perichondrium and the cartilage to accommodate remnants of the incus or handle of the malleus. The graft has a small perichondrial flap on the other end for firm anchorage to the arch of the stapes or the footplate. This allows the cartilage graft to be firmly anchored with the adjacent ossicular remnants. The presence of perichondrium with the graft helps to maintain nutrition, stiffness, and the configuration of the cartilage. With minor modifications, we have used this technique in 115 patients to reconstruct different types of ossicular defects, with commendable hearing results. Of the 115 operated ears, an air-bone gap closure within 10 dB was found in 14.8%, within 15 dB in 34.8%, and within 20 dB in 24.4% of ears. In another 20.8% of cases, the air-bone gap closure remained in the range of 25 dB or less. The longest follow-up was 13 years 7 months. The presented technique is easy and effective and solves most of the problems of cartilage ossiculoplasty.