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Effect of Graft Size on Air-bone Gap Closure in Cartilage Button Tympanoplasty
Lauren S Buck1, Ellen B Carter1, Christopher J Carron2
1Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi.
Insights
Graft size in cartilage tympanoplasty did not significantly impact hearing outcomes. However, larger grafts (over 5 mm) may reduce closure success, suggesting alternative techniques for extensive perforations.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Regenerative Medicine
Background:
- Tympanic membrane perforations are common in children.
- Cartilage tympanoplasty, particularly the butterfly inlay technique, is an effective repair method.
- The optimal graft size for butterfly inlay tympanoplasty remains under investigation.
Purpose of the Study:
- To evaluate the influence of circular punch graft size on postoperative air-bone gap in pediatric butterfly inlay cartilage tympanoplasty.
- To assess the relationship between graft diameter and tympanic membrane closure rates.
Main Methods:
- Retrospective case review of 52 children under 16 years old undergoing butterfly inlay tympanoplasty.
- Grafts of 4 mm, 5 mm, and 6 mm circular punch grafts were utilized.
- Postoperative pure-tone average and air-bone gap were the primary outcome measures.
Main Results:
- No significant difference in postoperative pure-tone average or air-bone gap was observed across 4 mm, 5 mm, and 6 mm graft size groups.
- Tympanic membrane closure rates were 94% for 4 mm, 96% for 5 mm, and 67% for 6 mm grafts.
- Overall closure rate was 92%.
Conclusions:
- Butterfly inlay tympanoplasty using circular punch grafts is effective for tympanic membrane repair with consistent hearing results across graft sizes.
- Grafts larger than 5 mm may be associated with decreased closure success.
- Further research with larger cohorts is recommended to explore optimal techniques for larger tympanic membrane defects.
Objective:
To study the effect of graft size on postoperative air-bone gap in children undergoing butterfly inlay cartilage tympanoplasty using circular punch grafts.
Study Design:
Retrospective case review.
Setting:
Tertiary, academic children's hospital.
Patients:
Children less than 16 years old undergoing circular butterfly inlay tympanoplasty using 4, 5, or 6 mm round grafts.
Intervention:
Butterfly inlay tympanoplasty using circular punch graft harvest technique.
Main Outcome Measures:
Postoperative pure-tone average and air-bone gap.
Results:
Fifty-two children were included in the analysis: 18 in the 4 mm group, 28 in the 5 mm group, and 6 in the 6 mm group. There was no significant difference in either postoperative pure-tone average or air-bone gap among the three groups. Closure rates for the 4, 5, and 6 mm graft groups were 94, 96, and 67%, respectively, for an overall rate of 92%.
Conclusions:
Cartilage button butterfly inlay tympanoplasty with punch graft is an effective method for tympanic membrane repair with similar hearing results among various graft diameters but may have diminished success with perforations requiring grafts larger than 5 mm. Larger case series are necessary to determine if larger defects are best managed with other repair techniques.
