Use of the Williams microclip in various aspects of tymanoplastic surgery

The microclip was invented by J. David Williams, M.D. in 1971 in an attempt to devise a technique to reliably secure a medially placed fascia graft to a tympanic membrane remnant. This method immediately improved the graft take rate to better than 90% in the Alaska native population with whom he was working. Included in this 90% and above category were many ears that demonstrated some degree of mucosal edema, granulation tissue, or mucopurulent discharge--referred to in this paper as the "wet ear." Anatomic and audiologic results of 286 consecutive otologic procedures requiring a tympanic membrane graft will be presented in which the Williams microclip has been employed to secure a medially placed graft. Attention well be devoted to both success and failure of the methods employed. Special attention will be given to the description of surgically challenging situations in tympanoplasty surgery such as "the narrow to non-existent remnent segment" where the microclip demonstrates its exceptional usefulness. Last, additional uses of the microclip (other than in tympanic membrane grafting) will be discussed including its application in a new technique of ossicular chain reconstruction. Case reports and statistical data will augment material presented.