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      Comparison of results of graft uptake using tragal cartilage perichondrium composite graft versus temporalis fascia in patients undergoing surgery for chronic otitis media – squamous type

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          Abstract

          Background

          To assess, analyze and compare the results of graft uptake using Tragal Cartilage-Perichondrium Composite (TCPC) graft with Temporalis Fascia (TF) graft in patients who undergoing surgery for chronic otitis media - squamous type.

          Methods

          Patients aged 13 years and above with diagnosis of chronic otitis media - squamous type undergoing modified radical mastoidectomy, either primary or revision surgery with grafting of tympanic membrane (TM) and patients undergoing excision of postero-superior retraction pocket (PSRP) were included in this study. Patients were divided in two groups: Group A-patients undergoing TCPC graft and Group B -patients undergoing TF graft. Graft uptake results were assessed between 8-12 weeks of surgery.

          Results

          In both Groups there were 30 patients each. In Group A successful graft uptake was seen in 27 patients (90 %) and failure of graft uptake was seen in 3 patients(10 %). In Group B successful graft uptake was seen in 28 patients (93.3 %) and failure in 2 patients (6.67 %).Out of the total 60 patients, 11 patients had PSRP. All 6 patients with PSRP in Group A had successful graft uptake and no retraction. Among the 5 patients with PSRP in Group B all patients had sucessful graft uptake, however, in 2 patients retraction of the tympanic membrane was seen similar to the preoperative findings.

          Conclusions

          There was no statistical difference ( p = 0.433) between the use of temporalis fascia or tragal cartilage perichondrium in patients undergoing surgery for chronic otitis media - squamous type.

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          Most cited references12

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          Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique.

          The use of cartilage as a grafting material has been advocated in cases at high risk for failure, such as subtotal perforations, adhesive processes, tympanosclerosis and residual defects after primary tympanoplasties. The cartilage palisade technique, in which the TM is fully reconstructed with palisade-shaped cartilage pieces, was first described by Heermann. Cartilage material has been criticized because of concerns regarding hearing results, however, large cartilage plates with thicknesses
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            Cartilage tympanoplasty.

            This chapter describes two techniques for cartilage reconstruction of the tympanic membrane: the perichondrium/cartilage island flap, which uses tragal cartilage, and the palisade technique, which uses cartilage from the tragus or cymba. The perichondrium/cartilage island flap is preferred for management of the atelectatic ear and the high-risk perforation. The palisade technique is preferred in cases of cholesteatoma and when ossicular reconstruction is needed in the malleus-present situation. Descriptions of the modifications that should be taken in response to specific surgical indications are also provided and include the high-risk perforation, the ear requiring ossiculoplasty, the atelectatic ear, cholesteatoma, and pervasive Eustachian tube dysfunction.
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              Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane.

              The use of cartilage in reconstruction of the tympanic membrane has been established especially in cases such as tubal dysfunction and adhesive processes. Cartilage offers the advantage of higher mechanical stability compared with membranous transplants but may alter the acoustic transfer characteristics of the graft. Apart from material properties, it can be assumed that, also, the microsurgical reconstruction technique might influence the sound transmission properties of the reconstructed tympanic membrane. The purpose of the study was to investigate the acoustic transfer characteristics of different cartilage transplants being typically used in different reconstruction techniques of the tympanic membrane. Cartilage plates of different thicknesses (1.0, 0.7, 0.5, and 0.3 mm), cartilage palisades, and cartilage island transplants of varying size were investigated by means of an ear canal-tympanic membrane model. In contrast to former single-point measurements, sound-induced vibrational amplitudes of the entire transplant were measured by scanning laser Doppler vibrometry (measuring points, n = 133) (PSV-200, Polytec, Waldbronn, Germany). Frequency response functions (displacement vs. sound pressure) of all measured points were determined in the frequency range of 200 Hz to 4 kHz for the different transplants. Cutting thick cartilage transplants into thin plates or palisades decreased the first resonance frequency and increased its amplitude, reflecting improved sound transmission properties of the transplant. From an acoustical point of view, the 0.5-mm cartilage plate seems preferable compared with the palisade technique. Cartilage island techniques showed vibration characteristics superior to plate or palisade techniques. Apart from material characteristics, the sound transmission properties of the reconstructed tympanic membrane are strongly influenced by the reconstruction technique. The choice of the surgical technique should consider requirements based on mechanical stability and acoustic transfer characteristics of the transplant.
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                Author and article information

                Contributors
                dr.khalilullahshaik@gmail.com
                drshankarshah@gmail.com
                dyd286@yahoo.com
                rakesh2019@gmail.com
                sukhaura@gmail.com
                Journal
                Head Face Med
                Head Face Med
                Head & Face Medicine
                BioMed Central (London )
                1746-160X
                2 August 2016
                2 August 2016
                2016
                : 12
                : 26
                Affiliations
                [1 ]Department of ENT & HNS, Government Medical College, Chandigarh, India
                [2 ]Department of ORL & HNS, BPKIHS, Dharan, Nepal
                [3 ]Department of ORL&HNS, PAHS, Kathmandu, Nepal
                [4 ]Department of ORL&HNS, TUTH, Kathmandu, Nepal
                Article
                123
                10.1186/s13005-016-0123-z
                4970281
                27485368
                45d929c1-e949-47da-8bf4-eae2603b691d
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 March 2016
                : 28 July 2016
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Orthopedics
                chronic otitis media-squamous type,tragal cartilage perichondrium composite graft,postero-superior retraction pocket

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