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Objective To describe a simple technique for harvesting tragal cartilage and describe its use in rhinoplasty. Study Design Retrospective review. Subjects and Methods Rhinoplasties performed between January 2005 and June 2007 in which tragal cartilage grafts were utilized by the senior author (CSC) were reviewed to assess type of graft, preservation of tragal contour, and donor-site morbidity. Results Tragal cartilage grafts were used in three primary and three secondary rhinoplasty patients. Postoperative follow-up ranged from six months to 12 months. Tragal cartilage was used as five alar contour grafts, one lateral crural onlay graft, one dorsal onlay graft, and one infratip lobule graft. Tragal cartilage was used to close the septal perforation of one patient. Tragal contour was preserved in all patients, and there were no complications noted with this procedure. Conclusion The tragus provides a simple, convenient alternative source of cartilage for rhinoplasty in graft-depleted patients.

The major drawback of combined approach tympanoplasty (CAT) is a relatively high rate of cholesteatoma recurrence compared to open-cavity techniques, which is thought to occur primarily by recurrence of retraction pockets. In this series of 63 CATs carried out by one surgeon, scutum reconstruction to prevent recurrent attic retraction was carried out in 43 cases. Repair with bone pate proved much more successful in achieving this (20.7%; 6/29 recurrent retraction pockets) compared to tragal cartilage (57.1%; 8/14) (Fisher's exact test, P = 0.0205) and was found to be a result of the greater incidence of cartilage resorption. Recurrence of retraction in pars tensa defects was more common as the only material used was a simple temporalis fascia graft. The mean time to development of recurrences was 21.1 months and that has important implications for follow-up. We conclude that the use of bone pate for scutum reconstructions reduces the incidence of attic retraction pockets, and therefore the risk of cholesteatoma recurrence following CAT.

Objectives:Evaluate the anatomical and audiological results of the endoscopic tympanoplasty with tragal perichondrium graft.Methods:A case series in patients with chronic otitis media, treated with transcanal endoscopic tympanoplasty by the under-over technique. Patients were followed six months post treatment with clinical and audiometric evaluations in the Department of Otolaryngology, National Hospital Arzobispo Loayza, Lima - Peru between 2007 and 2011.Results:Of a total of 64 patients, 31 met the inclusion criteria. 20 were males (64.5%) and the mean age was 27.5 years. The left ear was the most affected with 61.3%. Only 12.9% had retraction pocket. Perichondrium graft was used in 87.1%, and tragal cartilage with perichondrium with the others. There was complete closure of the perforation in 93.5% and only 2 complications, infection and perforation. The difference of the mean of the audiometries by air previous (39.1 ± 5.8) and posterior (30.2 ± 7.2) of surgery was significant (P = 0.0001). The diffe...

Objective: To see the efficacy of cartilage tympanoplasty in retraction pockets of tympanic membrane.Method: Prospective study conducted from 2009 to 2010. Disease studied: Retraction pockets in tympanic membrane. Subjects studied: Twenty. Setting: Tertiary care center. Interventions: The retraction pockets were excised and cartilage tympanoplasty using tragal cartilage and perichondrium was performed. Graft take-up, hearing improvement was noted and statistical significance was calculated.Results: Patients were followed up for a period of 6 months. Graft take-up was seen in 16 (80%) cases with residual perforation in 2 cases and recurrence of retraction pockets in 2 cases. The average preoperative hearing loss was 39.50 + 1.44 decibels, while the average postoperative hearing loss was 26.75 + 1.86 decibels, with a gain of 12.75 decibels (P value less than .01).Conclusion: Retraction pockets management by excision and cartilage tympanoplasty provides the tympanic membrane with greater strength and greatly...

Objective: 1) To evaluate 3 methods: conchal cartilage, tragal cartilage, and bone pate, for primary attic reconstruction (scutumplasty) in pediatric canal wall-up mastoidectomies in terms of recurrence rates and formation of retraction pockets.Method: All patients undergoing attic reconstruction following a canal wall up mastoidectomy were evaluated from a single surgeon prospective pediatric otological database maintained over a 10-year period. The reconstruction of the scutum defects was done using bone pate, conchal and tragal cartilage. The outcome measures were postoperative retraction pocket formation and recurrence of cholesteatoma.Results: A total of 120 patients underwent primary attic reconstruction following canal wall-up mastoidectomy over a 10-year period. The overall recurrence rate was 9.83% (n = 12). Fifty-one patients underwent attic reconstruction with tragal cartilage, while 33 were reconstructed using conchal cartilage and 36 with bone pate. The recurrence rate with various reconstruc...

ObjectiveTo report a modified technique of cartilage reinforcement tympanoplasty. To assess the safety and efficacy of this technique for symptomatic tympanic membrane retractions.MethodsRetrospective analysis of patients with Pars Tensa retractions treated surgically between 2001 and 2007. The indications were discharge and hearing loss. Surgery involved excision of retracted segment, exposure of facial recess, removal of keratin and reinforcement with thinned tragal cartilage graft (cartilage thinned by cartilage cutter) and temporalis fascia. Paired T test was used to compare the mean ABG before and after surgery.Results34 ears were operated on in 33 patients with an age range of 8 to 66 (mean 38). Full extent of the retraction was visible (Moderate) in 12 ears and not visible in 22 ears (Severe). Cholesteatoma was found in 10 ears (all in Severe group) and ossicular erosion was noticed in 29 ears. Follow-up ranged from 12 to 66 months (mean of 36 months). The success rate was 97% with recurrence of re...

We reviewed 564 tympanoplasties operated upon over an eight year period at the Otologic Medical Group in which tragal cartilage was used to re-establish the sound pressure transfer mechanism. Eighty-six percent of the cases were revisions, and half of these were planned second stage procedures. In the majority of cases the stapes crural arch was missing. The conductive deficit in these cases was reduced to 20 db or less in 67% and 10 db or less in 40%. The commonest single cause of failure was a short prosthesis. There were no instances of cartilage resorption. Extrusion occurred in one case. Tragal cartilage has been more satisfactory than ossicular tissue in many situations. Recently we have been using plastic prostheses (TORP and PORP) in combination with tragal cartilage and believe that the results will be even better.

Reconstruction of old radical cavities The methods as well as the primary and late results of 74 partial and 93 total reconstructions of old radical cavities were described. In partial reconstructions the tympanic cavity was reconstructed, but the cavity was not eliminated, as it was dry or could be kept dry. In total reconstructions the tympanic cavity and auditory canal were reconstructed, and in most cases the cavity was obliterated, either by muscle or by combined grafts of muscle, tragal cartilage, and homologous septal cartilage. On the basis of the late results, functionally 10–20% poorer than the primary ones, the indications for reconstruction of old radical cavities were discussed. If there is chronic aural discharge, and if the cavity is lined with granulations, the ear can be rendered dry by total reconstruction in 90% of the cases.

Following Palva's1 original description of the technique, the “swinging door” tympanoplasty was modified and reported by several otologic surgeons, including Glass-Cock,2,3 Fisch,4 Smyth,6 Pennington.6 The basic technique involves the elevation of superiorly based and inferiorly based canal skin flaps, or “swinging doors.” After dividing the posterior anulus, the flaps are rotated anteriorly, a maneuver that provides ample exposure of the middle ear and greatly simplifies underlay fascia grafting. The purpose of this article is to review this basic technique and to describe additional modifications that further simplify tympanoplasty grafting. These modifications include (1) canal flap advancement, (2) the use of multiple fascia grafts, (3) techniques for securing the graft to the malleus handle, and (4) the use of tragal cartilage in grafting. With this technique, a 95% take rate was observed at 3 months, and the graft was firmly attached to the malleus handle in all cases.

Correction of ossicular defects in tympanoplasty most commonly involves the use of commercially available prostheses or preserved allograft ossicles. Incus autografts and tragal cartilage autografts are also used by many surgeons. Presculptured preserved allograft ossicles have not been used widely, but are used almost exclusively by our clinic. The fate of ossicular grafts has been reported by a number of in investigators with evidence obtained at revision surgery. In this paper we will be able to trace the fate of a presculptured preserved autograft ossicle clinically and pathologically. The unique aspect of this study is the demonstration of the ossicular status in post mortem temporal bone dissection followed by histopathological serial section studies.

Recurrent cholesteatoma following atticotomy or combined-approach tympanoplasty remains a significant problem. The importance of closing defects created by surgery or disease in the posterosuperior bony canal is recognized, and numerous materials and techniques have been advocated. Our experience with a composite autograft of tragal cartilage and perichondrium in 40 ears is presented after 1 to 6 years follow-up. The composite autograft performed satisfactorily in 38 cases. In no case did recurrent cholesteatoma develop at the site of a defect that had been obliterated by the autograft.