Sinonasal Repair Graft for Pediatric Endoscopic Assisted Tympanic Membrane Repair: Implications of Graft Thickness

By June 7, 2019

Nickel, Nathan1; Varadarajan, Varun1; Schrepfer, Thomas1
1 University of Florida College of Medicine, Department of Otolaryngology Head and Neck Surgery, Gainesville, FL, USA.

Present a series of tympanoplasties using a sinonasal repair graft and discuss feasibility of sinonasal repair grafts for otologic surgery and implications of graft thickness on technique and outcome.

The Biodesign sinonasal repair graft is designed to aid the natural healing of surgically compromised tissue after endonasal surgery. The sinonasal repair graft has reduced thickness and cost when compared to the widely used Biodesign otologic repair graft. The use of the sinonasal repair graft in tympanoplasty has not been previously described.

Case series of pediatric patients with tympanic membrane perforations who underwent tympanoplasty using sinonasal repair grafts.

Main outcome measures included repair success, graft cost, thickness, and intraoperative tissue handling. The nominal thickness of the nasal septal implant is 0.20 millimeters (mm) in comparison to the 0.25 mm thickness of the otologic implant. Surgical approach, surgeon experience, prehydration, and defect size may influence tissue handling.

3 patients underwent transcanal endoscopic underlay tympanoplasty and 1 patient underwent retroauricular endoscopic-assisted underlay tympanoplasty. In the senior author’s experience, tissue handling was found to be more technically challenging in comparison to autologous grafts and otologic repair grafts. The sinonasal repair graft had reduced cost when compared to the otologic repair graft. 3 of 4 patients had successful perforation repair.

The nasal implant is a viable and cost-effective grafting substitute for tympanoplasty but may be more technically challenging to handle and position when compared to autologous and otologic repair grafts.