Experience of Inlay Technique in Endoscopic Myringoplasty Using Tragal Perichondrium

By June 7, 2019

Okano, Takayuki1
1 Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

The management of tympanic membrane perforation can be often challenging through a conventional transcanal approach depending on the anatomical characteristics with a narrow canal or with a prominent anterior overhang. Utilization of endoscopy the access to the anterior annulus and anterior edge of the malleus manubrium. The present study discusses the method and short-term results of inlay technique endoscopic myringoplasy using tragal perichondrium.

Methods and Results:
In the inlay technique, a tympanomeatal flap is raised, and dissection of the tympanic membrane is performed in the layer between the epithelium and the lamina propria. The graft is placed lateral to the annulus and any remaining lamina propria. There is an excellent visualization of tympanic membrane perforation in the anterosuperior quadrant without separation of the tympanic membrane from the malleus manubrium and umbo. In addition, the healing rate is thought to be high because the epithelium and the mucosa of the tympanic membrane are completely separated and the middle ear space is not reduced so that ventilation through tympanic cavity to the mastoid can be kept intact.
The inlay technique in endoscopic myringoplasty was employed in five patients. The causes of disease were exclusively infection including one case of intramenbrane cholesteatoma. Healing and hearing improvement were achieved in all patients without postoperative complication such as anterior blunting or postoperative perforation.

In order to achieve the best results in myringoplasty, an ear surgeon must be familiar with both underlay and inlay techniques, which should be employed based on the site of perforation, condition of patients, and the surgeon’s experience.