CONCLUSION
In order to improve the healing rate of large perforations, sub-total perforations and marginal perforations in the anterior inferior quadrant, we modified the traditional endoscopic cartilage myringoplasty by adding an extra perichondrium or cartilage patch to the anterior inferior edge of the perforation to enhance the contact between graft and tympanic membrane remnant. The using of an extra patch achieved a high healing rate and a statistically significant hearing gain. No major complications were observed during follow-up period. While this method improves the outcome of patients whose grafts did not well fit tympanic membrane during operation, it does not significantly prolong the operation time or increase the financial burden of patients, promoting its potential to be popularized in clinical practice. The clinical effectiveness and feasibility of this method can be further demonstrated by expanding the sample size and prolonging the follow-up time.
1. Klacansky J. Cartilage myringoplasty. Laryngoscope. 2009;119(11):2175-7.
2. Shekharappa MK, Siddappa SM. Cartilage Myringoplasty: An Ideal Grafting Technique for Complex Perforations. J Clin Diagn Res. 2017;11(7):MC06-MC8.
3. Aggarwal R, Saeed SR, Green KJ. Myringoplasty. J Laryngol Otol. 2006;120(6):429-32.
4. Carr SD, Strachan DR, Raine CH. Factors affecting myringoplasty success. J Laryngol Otol. 2015;129(1):23-6.
5. Zhang J, Wang ZY, Yang Q, Yang HD, Zhao Y, Yu YJ, et al. [A multi-center clinical retrospective study on the therapeutic effect of endoscopic myringoplasty]. Chinese Journal of Otorhinolaryngology Head and neck surgery. 2019;Vol.54,No.4(4):245-50.
6. WangJ., Ge QJ, Kang LP. Advance flap in repairing marginal perforation of tympanic membrane in 27 cases. Journal of Otolaryngology and ophthalmology of Shandong University. 2015;V01.24 No.6:15-6.
7. WangX.R., Zhang L, Li J, Jiang G, Wu X, Zhuang H. Endotoscopic myringoplasty for tympaIIic membrane marginal perf.0ration in anterior infbrior quadrant. Chinese Joumal of 0torhinolaryngology-Skull Base surgeIy. 2018;Vol.24 No.6:531-4.
8. Alain H, Esmat NH, Ohad H, Yona V, Nageris BI. Butterfly myringoplasty for total, subtotal, and annular perforations. Laryngoscope. 2016;126(11):2565-8.
9. Zheng CL. Endoscopic Cartilage Myringoplasty with Inside Out Elevation of a Tympanomeatal Flap for Repairing Anterior Tympanic Membrane Perforations. Annals of Otology, Rhinology & Laryngology 2020.
10. Li C, Wang B, Wang X, Zhang H, Li S, Liu H, et al. Observation of the short-term ef fect of tympanoplasty(type I )in dry and wet ears with chronic otitis media. J Clin Otorhinolaryngol Head Neck Surg(China). 2021 Vol.35,No.7:617-20.
11. Demir E, Coskun ZO, Celiker M, Terzi S, Erdivanli OC, Balaban GA, et al. Endoscopic butterfly inlay myringoplasty for large perforations. Eur Arch Otorhinolaryngol. 2019;276(10):2791-5.
12. Hyun Ji Kim MJK, Ju Hyun Jeon, Jung Min Kim, In Seok Moon, Won-Sang Lee. Functional and Practical Outcomes of Inlay Butterfly Cartilage Tympanoplasty. Otology & Neurotology. 2014;Vol.35,N0.8:1458-62.