Joseph Toynbee Memorial Lecture, 1976. Tympanoplasty--four heterodox techniques

Polarization between proponents of intact canal wall tympanoplasty and radical (modified) mastoidectomy in the treatment of cholesteatoma and other irreversible temporal bone lesions can be avoided in many cases by the use of one or more special techniques. These include (a) Gelfilm (no-graft) induction of tympanic membrane regrowth; (b) the use of tragal cartilage and perichondrium in columellization and in Type III neomyringostapediopexy; (c) the use of laboratory-prefabricated ossicular homografts to correct malleal-capitulum and malleal-footplate discontinuities more precisely; and (d) the circumferential approach (circumnavigation of patient's head) and anterior position of the surgeon in order to visualize the sinus tympani, retropyramidal, and retrofacial areas, obviating extensive posterior tympanotomy bone dissections. These techniques make possible a third alternative to the choice of either combined-approach tympanoplasty or radical or modified radical mastoidectomy in the treatment of a number of advanced temporal bone lesions.