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Cartilage perichondrium composite grafts (CPCG) have been used in tympanoplasty for many years. Reperforations can be seen because of various problems. The aim of our study is to describe a graft technique to minimise the complications and to evaluate the success of the graft. The ears which underwent type 1 tympanoplasty using CPCG were included in the study. Over-underlay graft technique was used in all operations. They were performed by microscopic transcanal approach and by the same surgeon. Fifty-four ear operations of 48 patients were included in the study. While the preoperative average pure tone- average (PTA) of the ears was 45 (21–75) dB, the postoperative average PTA was 28 (11–58) dB. While the preoperative air bone gap (ABG) of the ears was 23.3 (10-43.3) dB, the postoperative ABG was 11.6 (0-28.3) dB. A significant improvement was achieved in both ABG and PTA values after the operation (p < 0.001). The graft success rate was 94.4%. The cartilage graft modifications such as block cartilage, palisade, cartilage island and butterfly have been applied successfully. We aimed to reduce the risk of reperforation, maximise audiological gain and facilitate the follow-up of postoperative middle ear pathologies by thinning the cartilage island and extending the perichondrium to the external auditory canal in the modification of CPCG. The graft success rate and the audiological success rate are high enough to be compared with the literature. The described CPCG can be used safely in all types of perforations, especially in high-risk perforations. [ABSTRACT FROM AUTHOR]

Background Augmentation rhinoplasty requires graft with substantial volume. In cases where patient is reluctant to use costal cartilage, this can be done using septum and conchal cartilage graft. Using the technique of "stacked cartilage graft" an assembly is made using septum and conchal cartilage for nasal augmentation and contour defects. Although multilayered grafts have been described before, we propose an elaborate and effective method named after our city, Mumbai, to shape these grafts and highlight economical use of conchal and septal cartilage to overcome its limited volume. It also describes its clinical and aesthetic outcome of this technique in Indian patients. Materials and Methods A retrospective study from 2005 to 2020 was done in our institute. Data was collected from medical and hospital records. Preoperative and postoperative photographs were obtained for preoperative planning and outcome analysis. Rhinoplasty Outcome Evaluation score was used for outcome analysis. Minimum follow-up was 1 year in our study. Results A total of 210 patients were included in our study. In all cases, the stacked cartilage graft technique produced a natural appearing dorsum. Complications of cartilage such as resorption, extrusion, and warping were minimum. All the patients were satisfied with their results. Conclusion Although the limited volume of conchal cartilage is criticized, in reality it can be used effectively for larger requirement with "economy of use" using our technique. The curvatures and convolutions of conchal cartilage can be effectively neutralized by using this technique to obtain a smooth surface. However, this technique requires incorporation of every bit of cartilage and meticulous stacking of the pieces to get the desired shape. Thus, the stacked cartilage grafts have excellent versatility and produce natural and long-lasting results and minimal complications. [ABSTRACT FROM AUTHOR]

Binder’s syndrome, characterized by maxillonasal dysplasia, presents unique challenges in nasal reconstruction due to the complex skeletal deformities involved. This case report demonstrates the successful utilization of a costochondral graft for secondary augmentation rhinoplasty in a 21-year-old female patient with Binder’s syndrome-related nasal deformities. The management of nasomaxillary hypoplasia is crucial due to the significant role of midline structures in facial esthetics, where even minor deviations can lead to drastic changes in appearance, impacting both esthetics and the patient’s psychological well-being. The surgical techniques, preoperative planning, and postoperative outcomes are discussed, emphasizing the importance of tailored interventions in complex craniofacial reconstruction cases.

Objective: The objective of this study was to compare the postoperative infection and graft success rates, and the hearing improvement, after endoscopic cartilage underlay myringoplasty with versus without antibiotic ointment coating. Materials and methods: This was a retrospective case-control study. The clinical records of patients who underwent endoscopic cartilage underlay myringoplasty and who met the selection criteria were retrieved and divided based on middle ear packing status into groups with antibiotic ointment packing (AOP group) and with no antibiotic ointment packing (no-AOP group). The operation time, postoperative infection, graft success status, and hearing improvement were compared between the 2 groups. Results: Patients with 166 perforations constituted the AOP group, and patients with 141 perforations comprised the no-AOP group. At 3 months postoperatively, middle ear infections had occurred in 24 (14.5%) ears in the AOP group and 4 (2.8%) ears in the no-AOP group (P <.01). At 12 months postoperatively, the graft success rate was 81.3% in the AOP group and 97.9% in the no-AOP group (P <.01). No significant group differences were observed, preoperatively (P =.657) or postoperatively (P =.578), in the air-bone gap (ABG) values or mean ABG gains (P =.758). Conclusion: Middle ear packing without antibiotic ointment coating does not increase the postoperative infection rate or reduce the graft success rate after endoscopic cartilage underlay myringoplasty compared to antibiotic ointment coating. On the contrary, coating with antibiotic ointment increases the risk of postoperative infection given the complexity of middle ear manipulation. [ABSTRACT FROM AUTHOR]

Background: Facial balance significantly impacts aesthetics, particularly in the middle and lower thirds. Patients with chin retrusion often benefit from sagittal plane chin advancement in rhinoplasty, enhancing surgical outcomes and satisfaction. Objectives: This article presents a method for analyzing chin deformities and discusses a hybrid treatment approach to harmonize facial features, complementing rhinoplasty. Methods: The chin positions of patients treated by the senior author were assessed. A retrospective analysis included 49 patients with chin retrusion of 2.5–6 mm. Among them, 22 patients initially offered chin implants declined, leading to planned chin augmentation. Fat grafting was exclusively performed for 20 patients lacking sufficient cartilage. The "Hybrid Chin Advancement" technique involved supporting tissues beneath muscles with nasal septum cartilage and fat injections and tissues above muscles with fat injection alone. Results: Pre- and postoperative Legan angle measurements and chin advancements were compared across three groups. While preoperative Legan angles were statistically similar, postoperative Legan angles and advancement changes were significantly higher in the implant group (p < 0.0001). Comparing hybrid chin advancement and fat grafting groups, postoperative Legan angles and advancement changes were significantly higher in the hybrid chin group (p < 0.0001). Conclusions: Fat grafting suffices for mild advancements (~ 2 mm), while the hybrid chin method is effective for moderate advancements (~ 4 mm). For advancements exceeding 6 mm, implants or osseous genioplasty are optimal. Our study's hybrid approach offers an easy, safe, and reliable method for achieving facial harmony in the lower two-thirds without compromising patient expectations. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical outcomes of patients who underwent surgical repair through an anterior approach that involved interposition a posterior cartilage for Type III or Type IV laryngotracheoesophageal cleft (LTEC). Methods: A chart view was performed on patients with Type III or Type IV LTEC between May 2017 and May 2022. Demographic features and surgical outcomes were collected and analyzed. Results: Seven patients were finally included. Five patients were diagnosed with Type III LTEC and two patients were diagnosed with Type IV LTEC. All but one patients survived and thrived. Four patients were able to successfully extubate with acceptable voice, and two patients were tracheostomized. Five patients were deemed safe for all consistencies food and one was safe for thickened food. After a mean follow-up of 49 months (18–83 months), neither complications nor recurrences were observed. Conclusion: An anterior laryngofissure approach to the cleft repair with a posterior cartilage grafting is an effective and safe treatment for Type III or IV LTEC, which enables closure of LTEC and reconstruction of cricoid plate in order to avoid tracheoesophageal fistula formation or subglottic stenosis postoperatively. Severe tracheomalacia and GERD are two main causes for surgical failure. [ABSTRACT FROM AUTHOR]

BackgroundThe temporal muscle fascia is the most widely used type of tissue graft in revision myringoplasty procedures. The aim of this study was to verify if the use of a cartilage graft may be a valid alternative to temporalis fascia. Tympanic reperforations are frequent after myringoplasty, especially in complicated, large, or anterior perforations, so we decided to compare the neodrum stability of two different surgical techniques.Materials and methodsThe study was conducted on 42 patients who underwent revision myringoplasty, carried out with the overlay technique, between 2004 and 2020. In all patients, the retroauricular approach was used. The subjects included in the study were divided into 2 groups: the former was treated with a cartilage graft, while in the latter a temporalis fascia graft was used. In the comparison of the two groups, the following outcomes were taken into consideration: engraftment rate, incidence of complications, pre- and postoperative air conduction pure tone average and air-bone gap.ResultsThe success rate was 100% for the first group and 83.3% for the second, with a statistically not significant difference. Among the subjects treated with cartilage graft, complications were observed in 8.3% of the cases, while in patients treated with fascia graft the observed complication rate was 43.3% (p = 0.03), maybe due to the shorter follow-up period of the first group. The improvement of the air conduction pure tone average was greater with cartilage graft (p = 0.02), whereas the difference between air-bone gap closures in the two groups was not statistically significant.ConclusionThe cartilage graft can represent a valid alternative to temporal muscle fascia, guaranteeing excellent engraftment, fewer complication rate and satisfactory hearing outcomes.

Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose. This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry. A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools. Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups. Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts. [ABSTRACT FROM AUTHOR]

Purpose: To examine the factors that affect graft healing after laryngotracheal reconstruction (LTR). Methods: We conducted a retrospective chart review at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between January-2008 and October-2023. We included all patients who underwent LTR and required anterior and/or posterior graft placement, while those who underwent procedures without graft placement and those with incomplete information were excluded. Results: Forty-nine patients were analyzed. Most patients were pediatric (65.3%), male (65.3%), had no coexisting comorbidities (55.1%), and harbored grade 3–4 stenosis (59.2%). Thirty patients (61.2%) underwent open surgery. Various graft complications occurred including infection (n = 1, 2%), dehiscence (n = 3, 6.1%), scar (n = 6, 12.2%), and granulation (n = 29, 59.2%). Only 15 patients (30.65%) achieved the composite status of "healthy" graft. Among 43 patients who had postoperative cultures, positive results for Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were observed in 10 and four patients, respectively. Open surgery and double-stage procedure were significantly associated with higher rates of granulation tissue formation. Pediatric-age group had significantly higher rate of complete epithelization compared to adult-age group. A significantly greater proportion of patients who had unhealthy grafts had open surgery. The rate of double-stage LTR was significantly higher in unhealthy grafts compared to healthy grafts. Prolonged stent duration was linked to various graft-related complications. Multivariate logistic regression analyses showed no statistically significant correlations between various factors and postoperative graft-related complications. Conclusion: Open surgery, double-stage procedure, pediatric age group, and stent duration were not significant risk factors associated with postoperative graft-related complications during LTR in multivariate analysis. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Objective: The objective of this study was to compare the graft outcomes and complications of two endoscopic perichondrium–cartilage graft techniques for repairing large perforations. Study design: Single center blinded randomized controlled trial. Materials and methods: 61 large perforations more than 50% of TM area were prospectively randomized to undergo the free perichondrium and free cartilage graft group (FPFC, n = 31) or perichondrium partial attachment the cartilage graft group (PPAC, n = 30). The primary outcome measures were the operation time; secondary outcome measures were the graft success rate and hearing gain at 12 months postoperatively and postoperative complications. Results: All patients completed follow-up of 12 months. The mean operation time was 38.2 ± 2.3 min in the FPFC group and 37.4 ± 5.6 min in the PPAC group (P = 0.658). At postoperative 3 months, the graft success rates were 96.7% in the FPFC group and 93.3% in the PPAC group (P = 0.976). At postoperative 12 months, the graft success rates were 96.7% in the FPFC group and 83.3% in the PPAC group (P = 0.182). However, the residual and re-perforation rate with no infection was 0.0% (0/31) in the FPFC group and 16.7% (5/30) in the PPAC group (P = 0.056). No significant between-group differences were observed pre- (P = 0.842) or post- (P = 0.759) operative air bone gap (ABG) values or mean ABG gain (P = 0.886). However, granular myringitis has been noted in 6.5% in the FPFC group and in 3.3% in the PPAC group. Conclusions: This study suggested that 12-month graft success and hearing gain were comparable between the perichondrium free and partial attachment the cartilage graft techniques, nevertheless, partial attachment technique could increase residual and re-perforations. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability. [ABSTRACT FROM AUTHOR]

Abstract Objective This study evaluated the graft success rate and hearing outcomes of the inside-out raising mucosal-tympanomeatal flap technique for the repair of large marginal perforations. Study design Prospective case series. Materials and methods The study enrolled patients with large marginal perforations who underwent endoscopic cartilage myringoplasty with the inside-out raising mucosal-tympanomeatal flap technique. The graft success rate, hearing outcomes, and complications were evaluated at 12 months postoperatively. Results In total, 48 patients with large marginal perforations were included. 81% of the population had large perforation, 14.6 had subtotal and total perforation was seen in 4.2%. The mean operation time was 38.6 ± 7.1 min. At 12 months postoperatively, the graft success rate was 89.6% (43/48). The mean air-bone gap was 25.6 ± 5.2 dB preoperatively and 16.5 ± 4.1 dB at 12 months postoperatively, with significant differences between these values (p = 0.001). The functional success rate was 85.4% (41/48). None of the patients experienced worsened sensorineural hearing loss or graft-related complications, such as graft lateralization, significant blunting, and graft medialization, during follow-up. Conclusions Endoscopic cartilage-perichondrium myringoplasty for the repair of large marginal perforations using the inside-out raising mucosal-tympanomeatal flap technique was associated with satisfactory graft outcomes and minimal complications.

Background and objective. Nasal trauma is one of the main causes of acquired nasal deformity in adults. Cartilage grafts are frequently used in post-traumatic rhinoplasty and secondary rhinoplasty. Autologous costal cartilage is one of the options for the replacement of the deficient nasal osteocartilaginous framework, providing sufficient material availability in a single block of cartilage. We present our experience with the use of costal cartilage grafts in post-traumatic rhinoplasty, our surgical technique and the results obtained. Methods. We review 15 patients with a history of nasal trauma and saddle nasal deformity who underwent rhinoplasty with the use of costal cartilage graft. Graft types, complications and surgical outcome were analyzed. Graft preparation techniques and cartilage extraction were also reviewed. All patients underwent deferred surgery for nasal trauma. Results. The average age of the 15 patients was 35 years, the average postoperative follow-up was 16 months and the average operation time was 120 minutes. The types of cartilage grafts used were extended spreader grafts in all the patients, septal and alar extension graft in 13%, columellar strut in 87%, nasal dorsum in 67% and nasal tip in 7%. No pneumothorax occurred in any patient. There were no complications and only 2 revisions were necessary due to deviation of the dorsal cartilage and to nasal orifice asymmetry. Conclusions. In our experience, the use of costal cartilage autograft in rhinoplasty with post-trauma saddle deformity allows to obtain satisfactory results. It is our choice when we do not have adequate septal cartilage, as it allows an adequate amount of material for the necessary grafts. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the graft success rate and hearing outcomes of the inside-out raising mucosal-tympanomeatal flap technique for the repair of large marginal perforations. Study design: Prospective case series. Materials and methods: The study enrolled patients with large marginal perforations who underwent endoscopic cartilage myringoplasty with the inside-out raising mucosal-tympanomeatal flap technique. The graft success rate, hearing outcomes, and complications were evaluated at 12 months postoperatively. Results: In total, 48 patients with large marginal perforations were included. 81% of the population had large perforation, 14.6 had subtotal and total perforation was seen in 4.2%. The mean operation time was 38.6 ± 7.1 min. At 12 months postoperatively, the graft success rate was 89.6% (43/48). The mean air-bone gap was 25.6 ± 5.2 dB preoperatively and 16.5 ± 4.1 dB at 12 months postoperatively, with significant differences between these values (p = 0.001). The functional success rate was 85.4% (41/48). None of the patients experienced worsened sensorineural hearing loss or graft-related complications, such as graft lateralization, significant blunting, and graft medialization, during follow-up. Conclusions: Endoscopic cartilage-perichondrium myringoplasty for the repair of large marginal perforations using the inside-out raising mucosal-tympanomeatal flap technique was associated with satisfactory graft outcomes and minimal complications. [ABSTRACT FROM AUTHOR]

The primary objective of mastoid obliteration is the eradication of the disease and prevention of its recurrence. We intend to evaluate the impact of mastoid obliteration using autologous materials on the achievement of a dry mastoid bowl and frequency of maintenance care and hearing outcome of the operated ear. This was a hospital-based, non – randomized, prospective study. The study was performed over a period of 2 years. The study was performed in the Department of ENT of a tertiary care teaching hospital. Patients of chronic otitis media – squamosal type underwent canal wall down mastoidectomy and patients were divided into 2 groups of obliterated and non-obliterated. The canal wall obliterated patients were further compared in 3 groups based on the technique of mastoid obliteration used – bone dust, musculo-periosteal flap and cartilage graft. 6 months post-operative mastoid cavity epithelisation based on oto-microscopy and hearing outcome based on pure tone audiometry findings were compared. Majority of patients at 6-months follow-up found that epithelization was most common status of mastoid cavity with musculoperiosteal flap and discharge was commonest with cartilage graft. Mastoid obliteration with autologous materials is a safe and effective method to achieve a dry, safe and useful ear. In this study, musculo-periosteal flap being significantly better in terms of a well epithelized cavity and hearing outcome. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore the method of adding a secondary perichondrium patch to enhance the primary cartilage–perichondrium patch during endoscopic myringoplasty and to evaluate the effectiveness of this method in terms of healing rate and post-operative hearing of patients with poor prognostic factors (eustachian tube dysfunction, large perforations, subtotal perforations, and anterior marginal perforations). Design: This retrospective study analyzed a total of 80 patients (36 females and 44 males, median age of 40.55 years) who had received a secondary perichondrium patch during endoscopic cartilage myringoplasty. Patients were followed up for 6 months. Healing rates, complications, preoperative and postoperative pure-tone average (PTA) and air–bone gap (ABG) were analyzed. Results: At 6-month follow-up, the healing rate of tympanic membrane was 97.5% (78/80). The mean pure-tone average (PTA) improved from 43.18 ± 14.57 dB HL pre-operatively to 27.08 ± 9.36 dB HL 6 months after the operation (P = 0.002). Similarly, the mean ABG improved from 19.05 ± 5.72 dB HL pre-operatively to 9.36 ± 3.75 dB HL (P = 0.0019) at 6 months after the operation. Major complications were not observed during follow-up. Conclusions: The use of a secondary perichondrium patch during endoscopic cartilage myringoplasty for large, subtotal and marginal tympanic membrane perforations achieved a high healing rate and a statistically significant hearing gain with low incidence of complications. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare graft outcome, operation time and surgical complications of the double and single perichondrium–cartilage underlay techniques for repairing subtotal tympanic membrane (TM) perforations. Materials and methods: Patients with unilateral subtotal perforations undergoing myringoplasty were prospectively randomized to undergo DPCN or SPCN. The operation time, graft success rate, audiometric outcomes, and complications were compared between these groups. Results: In total, 53 patients with unilateral subtotal perforations were included (DPCN group, 27; SPCN group, 26).All patients completed 6 months of follow-up. The mean operation time was 41.2 ± 1.8 min in the DPCN group and 37.2 ± 5.4 min in the SPCN group, the difference was not significant (p = 0.613).The graft success rates were 96.3% (26/27) in the DPCN group and 73.1% (19/26) in the SPCN group, the difference was significant (p = 0.048). During the period of follow-up, residual perforation was found at postoperative in one (3.7%) in the DPCN group, while cartilage graft slipped (graft lateralization) in 2 (7.7%) and residual perforation in 5 (19.2%) were found in the SPCN group, the difference of residual perforation was not significant among two group (p = 0.177).In addition, no significant between-group differences were observed pre- (p = 0.741) or post- (p = 0.687) operative ABG values or mean ABG gain (p = 0.659) (Table 2).The functional success rates (postoperative ABG ≤ 20 dB) were 85.2% (23/27) in the DPCN group and 73.1% (19/26) in the SPCN group (p = 0.454). Conclusion: Although similar functional result and operation time can be obtained with double perichondrium–cartilage underlay technique compared to the single perichondrium–cartilage underlay technique for endoscopic closure of subtotal perforations, double unerlay technique offers better anatomical result with minimum complications. [ABSTRACT FROM AUTHOR]

Objective: To compare the operation times, graft survival and success rates, audiometric outcomes, and complications of patients who underwent transperforation myringoplasty with and without packing but without perforation rimming. Study Design: A prospective, randomized controlled trial. Setting: A university‐affiliated teaching hospital. Methods: We conducted a randomized controlled trial that enrolled patients who underwent underlay myringoplasty. No patient underwent perforation rimming. Patients underwent myringoplasty with or without graft lateral packing. The operation times, graft survival and success rates, audiometric outcomes, and complications were compared between the 2 groups. Results: Sixty patients with unilateral perforations were included. The mean neovascularization score at postoperative week 2 was significantly higher in the no‐packing group than in the packing group (p <.01) but did not differ significantly at postoperative weeks 3 and 4, or postoperative month 3. Neither the graft healing rate (p =.313) nor the perforation closure rate (p =.640) significantly differed between the 2 groups. The mean air‐bone gap improved by 8.91 ± 5.45 dB in the packing group and 8.17 ± 1.19 dB in the no‐packing group (p =.758). Conclusion: The long‐term graft success and hearing improvements in transperforation myringoplasty with no rimming of the perforation and no‐graft lateral packing were comparable to those in the graft lateral packing group with no rimming of the perforation, with a low incidence of complications. These results may change the traditional practice of packing the external auditory canal and rimming the perforation in underlay myringoplasty, even for all myringoplasty surgery. [ABSTRACT FROM AUTHOR]

Objective: Here, we aimed to compare the operation time, postoperative pain score, graft healing, graft success rate, cholesteatoma incidence, audiometric outcomes, and complications between endoscopic modified myringoplasty (EMM) and endoscopic typical myringoplasty (ETM). Methods: Patients with unilateral chronic tympanic membrane (TM) perforations undergoing myringoplasty were prospectively randomized to undergo EMM (n = 44) or ETM (n = 45). The operation time, postoperative pain score, graft healing, graft success rate, cholesteatoma incidence, audiometric outcomes, and complications were compared between these groups. Results: In total, 89 patients with unilateral chronic perforations were included (EMM group, 44; ETM group, 45). There were significant differences between the EMM and ETM groups in mean pain scores on the day after surgery (1.32 ± 0.56 vs. 2.58 ± 1.16, p < 0.001) and in the mean operation time (18.18 ± 2.43 vs. 51.53 ± 8.28 min, p < 0.001). There were no significant differences in graft success rates (93.18% vs. 88.89%, p = 0.735), pre‐ or postoperative air conduction pure‐tone averages or air bone gaps (ABGs), or changes in ABGs between the groups. However, the difference in graft healing was significant at postoperative week 2 (33/44 vs. 24/45, p = 0.033) but was nonsignificant at postoperative week 4 and month 6. Computed tomography revealed the middle ear and mastoid to be well pneumatized at 12 months in all patients. Conclusion: While 12‐month graft and audiometric outcomes were comparable between EMM and ETM techniques, patients who underwent EMM had less postoperative pain, shorter operative times, faster healing, and a lower incidence of complications. Level of Evidence: 1 Laryngoscope, 133:2779–2785, 2023 [ABSTRACT FROM AUTHOR]

The discovery of alternative implants with regenerative potential comparable to autologous cartilage continues to be encouraged because of the high donor site morbidity rate. This research tries to make an alternative implant that uses the concept of tissue engineering techniques in the form of endogenous regeneration by combining Decellularized Bovine Cartilage scaffold with Platelet-Rich Fibrin (BCPRF) which is implanted subcutaneously. The aim of this study was to compare the potential for chondroregeneration between BCPRF and autologous cartilage as assessed by chondrocyte cell formation, type 2 collagen thickness, and implant resorption rate in subcutaneous implantation. Using the research design method is a pretest-posttest control group design using New Zealand white rabbits. Forty eight experimental samples were divided into 2 groups which were treated with BCPRF and autologous cartilage implantation. Results were evaluated after 6 weeks. Evaluation was carried out on 39 samples. Microscopy showed better potential for autologous cartilage chondroregeneration than BCPRF with significant differences in the number of chondrocytes formed, the thickness of type 2 collagen (p=0.000), and the rate of implant resorption (p=0.000). In conclusion, the potential for chondroregeneration of autologous cartilage and BCPRF is significantly different in terms of the number of chondrocytes formed, the thickness of type 2 collagen, and the rate of implant resorption. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to investigate the effect of cartilage island grafts used in type 1 tympanoplasty surgery on compliance and hearing results. Methods: In this retrospective study, the medical records of patients who underwent type 1 tympanoplasty between May 2019 and December 2021 were reviewed. A total of 40 patients were included in the study. Preoperative audiological and tympanometry test results were compared with 6-month postoperative results. The effect of cartilage island graft on compliance and hearing levels was compared, preoperatively and postoperatively at the 6th-month follow-up. Results: Forty percent of patients were male, and 60% were female (n=24). The mean age of patients was 41,2±12.5 years. All postoperative tympanometry results showed a type B tympanogram tracing, as a result, no compliance was detected. At 500 Hz-4000 Hz frequencies, both air conduction hearing levels and air-bone gap thresholds showed a statistically significant improvement (p

Cartilage grafts are well-known as being reliable in reconstructive surgery for craniofacial pathologies. The aim of this study is to describe a new technique which requires an incision smaller than 1.5 cm but is still effective for harvesting cartilage graft. Thirty-six patients who underwent costal cartilage harvesting for septorhinoplasty have been included in this study, admitted from January 2018 to December 2021. Out of 36 patients, 34 have not reported any major complications, and two cases were followed up for pneumothorax. There were no infections and no chest wall deformities. All patients reported minimal pain at the donor site. The Vancouver Scar Scale was used to evaluate the entity of the postoperative scarring phenomena. This scale total ranges from 0 (representing normal skin) to a maximum score of 13 (representing worst scar imaginable). The results were 1.53 SD ± 0.64 (on average) 1 week after the surgical procedure and 1.28 SD ± 0.45 (on average) at the 6 months follow-up. This minimally invasive method provided a valid and effective surgical technique for cartilage graft. Despite the limitations of the case series, it seems that this procedure might be comparable to other and well-established traditional procedures and could be even preferred when the minimal invasiveness is mandatory. [ABSTRACT FROM AUTHOR]

Tympanic membrane perforation in children usually appears as a sequel of middle ear infection. This study was conducted to compare the anatomical and functional outcomes of cartilage and temporalis fascia graft in type 1 tympanoplasty in Paediatric population. Design: A hospital based randomized controlled trial. Setting: A tertiary care institute of central India. Subjects: All consecutive paediatric patients between 5 and 18 years of either sex attending ENT OPD and Paediatric OPD fulfilling inclusion criteria were included in the study. Anatomical and functional results of total 90 patients who underwent tympanoplasty were analyzed. These patients were divided into two groups depending on the graft material used. The cartilage group and the temporalis fascia group each comprising of 45 patients respectively. Methods: All patients underwent Type I tympanoplasty under general anaesthesia and with a post auricular approach. The surgeries were performed by senior surgeons. The graft success rate of the cartilage group (91.1%) was higher than the fascia group (84.44%) but the difference was not statistically significant (p = 0.449). The air bone gap closure was slightly better with temporalis fascia group than with cartilage group but the overall functional success rate in both the groups was not statistically significant.Cartilage and fascia grafts yield similar results for hearing gain and graft success rate in paediatric tympanoplasty. [ABSTRACT FROM AUTHOR]

Abstract Objective To compare the indications and efficacy of endoscopic over‐under tympanoplasty versus endoscopic underlay tympanoplasty. Methods Retrospective cohort study of patients undergoing type I endoscopic tympanoplasty via either an underlay or over‐under technique by a single surgeon from 2017 to 2021. Patients were excluded if they had a concurrent mastoidectomy, ossiculoplasty, or advanced cholesteatoma defined by involvement of multiple subsites. Patient demographics, perforation size and location, middle ear status, preoperative and postoperative audiograms, and perforation closure were reviewed. Middle ear status was represented using the Ossiculoplasty Outcome Parameter Score (OOPS). The primary outcome was perforation closure at most recent follow‐up and secondary outcomes were change in postoperative pure‐tone average (PTA) and air‐bone gap (ABG). Results Of 48 patients, 27 underwent endoscopic underlay tympanoplasty and 21 underwent endoscopic over‐under tympanoplasty. Tragal cartilage‐perichondrium graft was used in 90% of procedures. Distribution of OOPS scores was not significantly different between groups. Over‐ under technique addressed significantly larger perforations (mean size of 54% vs. 31%, p

This study aims to compare the graft success and hearing results of the palisade and island cartilage graft, with wheel-shaped composite cartilage graft (WsCCG) for type 1 tympanoplasty. The study was designed retrospectively. Only patients with conductive hearing loss and simple pars tensa perforation of the tympanic membrane were included in the study. Pure tone average (PTA), air–bone gap gain (ABG), word recognition score (WRS), ABG closure and grafts success were compared between the graft groups. Records of 111 patients were analyzed. The graft success rate was 89.7% for palisade cartilage graft (PCG, n = 39), 86.1% for island cartilage graft (ICG, n = 36), and 97.2% for wheel-shaped composite cartilage graft (WsCCG, n = 36) (p = 0.244). Average postoperative PTA and ABG values were significantly affected by the cartilage graft type, but WRS was not affected. (p = 0.005, 0.019, 0.306, respectively, One Way-Anova test). Post-Hoc LSD test showed a statistically significant decrease in PTA and ABG averages for WsCCG group compared to the ICG group (p = 0.004; CI%95 = 15.1–2.2 dB and p = 0.023; CI%95 = 8.2–0.4 dB, respectively). Postoperative PTA and ABG averages for WsCCG and PCG groups were similar (p = 0.069 and p = 0.053, respectively). In addition, while there were 2 (5.1%) retractions in the PCG group and 1 (2.7%)in the ICG group, there was no retraction in the WsCCG group. The WsCCG provided comparable results with classical reliable graft techniques (PCG and ICG) and may recommend as a more suitable graft due to hearing results and resistance against retraction. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to investigate the histopathological effects of 2-octyl-cyanoacrylate used in facial plastic operations that are applied for the fixation of cartilage graft types and the graft stabilization effect. Methods: In the study, 16 New Zealand-type rabbits weighing between 2250 g and 2500 g, 3-4 months old, were used. Two groups were formed as the study and control groups. Those using 2-octyl-cyanoacrylate for cartilage graft fixation were defined as the study group. Those using suturing were defined as the control group. The operation was planned with cartilage grafts taken from the ears of each rabbit and the study group on the left of the sagittal suture and the control group on the right. Results: Acute inflammation findings were found in 19 (39.6%) of the study group and 6 (14%) of the control group. Acute inflammation levels were found to be higher in the study group than in the control group (P = .006). Mild inflammation was found in 20 (41.7%) of the study group, moderate inflammation in 7 (14.6%), and severe inflammation in 2 (4.2%). Mild inflammation was detected in 10 (23.3%) of the control group. Chronic inflammation levels were higher in the study group than in the control group. Foreign body reaction was detected in 28 (58.3%) of the study group and 14 (32.6%) of the control group. Foreign body reaction levels were found to be higher in the study group than in the control group. Conclusion: We think that the use of 2-octyl-cyanoacrylate in cartilage graft fixation is not correct as it may increase the risk of postoperative complications. [ABSTRACT FROM AUTHOR]

Airway obstruction is a possible sequela following reconstruction of the nose after Mohs excision of skin cancers. While the principles and goals of tissue replacement after Mohs micrographic surgery are well-established, less attention has been paid to the evaluation of the nasal airway after reconstruction. Reconstructive planning begins with understanding the risk factors associated with the development of nasal valve compromise. Several approaches to prevent and correct nasal valve narrowing will be reviewed as part of a unified reconstructive plan for patients after skin cancer excision in high risk areas., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Patients who underwent cleft lip surgery in childhood may develop nasal malformation later in life. Various procedures have been described to correct these malformations. This study aims to describe our surgical approach and assess the morphometric outcomes of secondary cleft-lip rhinoplasty performed at the plastic surgery department in Marseille between 2002 and 2022. We conducted an analysis of surgical procedures and nasal morphometrics results by measuring pre- and postoperative images. Both surgical procedures and nasal morphometric analyses have been performed. This study included 43 patients, with 70% presenting unilateral cleft lip and 30% bilateral cleft-lip. An open approach was performed in 90% of cases. Regarding the surgical steps, a tip rhinoplasty, tip reinforcement, and crus lateral reinforcement by cartilage grafting was performed in 98%, 96%, and 32% of cases. A septal extension graft, a columellar strut, and a "tongue in groove" technique were performed in 54%, 33%, and 4% of cases, respectively, to reinforce the tip. Cartilage harvested from the nasal septum, ribs, and ear was utilized in 44%, 23%, and 20% of cases. An osteotomy, septoplasty associated with a spreader-flap, alar base reduction, and alar to triangular cartilage fixation were performed in 67%, 79%, 16%, and 16% of cases. All pre- and postoperative nasal morphometrics measurements have demonstrated a statistical significant improvement in nasal morphology following surgery. An open approach rhinoplasty, facilitating alar cartilage dissection and reinforcement by septal, rib, or ear cartilage is crucial to preserve postoperative outcomes. Our technique enables favorable mid-term results on secondary cleft-lip rhinoplasty., Competing Interests: Disclosure of interest The authors declare that they have no competing interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: This study was performed to compare the efficacy of the endoscopic modified cartilage over-underlay technique with and without packing for repairing chronic tympanic membrane (TM) perforations. Methods: A total of 70 cases of chronic TM perforation were randomly allocated to endoscopic modified cartilage over-underlay myringoplasty groups with (n = 35) and without (n = 35) packing. The graft success rate and hearing outcomes were compared between the two groups. In addition, neovascularization scores were subjectively obtained. Results: At 12 months postoperatively, the difference in graft success rate between the packing and no-packing groups was not significant (94.3% vs. 100.0%, P = 0.473). In addition, there were no significant differences between the two groups in the pre- or postoperative air–bone gap (ABG) (15.18 ± 2.73 vs. 15.07 ± 4.02, P = 0.623 and 8.63 ± 3.03 vs. 8.52 ± 4.50, P = 0.591) or mean ABG gain (6.56 ± 3.23 vs. 6.54 ± 2.83, P = 0.751). However, the average operating times were 43.6 ± 7.1 and 32.7 ± 2.1 min in the packing and no-packing groups, respectively (P < 0.001). Conclusions: Surgical and hearing outcomes were comparable between patients with chronic TM perforation treated using the endoscopic modified over-underlay technique with and without packing. However, without packing, the procedure was less invasive and had a shorter operating time. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of this prospective, randomized‐controlled study is to analyze the outcomes of a new graft technique in tympanoplasty and compare its outcomes with cartilage island graft plus extra perichondrium. Methods A total of 44 patients with noncomplicated chronic otitis media were included in this prospective randomized‐controlled clinical trial. Patients were randomly divided into 2 double‐layer graft groups: The cartilage island graft + cubism graft (study group) and the cartilage island graft + extra perichondrium (control group). The main outcome measures of the study were the air‐bone gap (ABG), ABG gain, and graft status. Results Graft success rate was 100% and 95.5% in the study group and the control group, respectively. There were statistically significant differences in the postoperative first month ABG and ABG gain between study and control groups (P .05). Conclusion This study revealed that both graft techniques have satisfactory functional and morphological results compared to preoperative findings. The use of cubism graft with cartilage island graft has significantly better auditory outcomes in short‐term and similar results in long‐term compared to double‐layered cartilage island graft with extra perichondrium. Cubism graft is a highly promising graft technique with its many advantages. Level of Evidence 1b.

Objective: To compare the indications and efficacy of endoscopic over‐under tympanoplasty versus endoscopic underlay tympanoplasty. Methods: Retrospective cohort study of patients undergoing type I endoscopic tympanoplasty via either an underlay or over‐under technique by a single surgeon from 2017 to 2021. Patients were excluded if they had a concurrent mastoidectomy, ossiculoplasty, or advanced cholesteatoma defined by involvement of multiple subsites. Patient demographics, perforation size and location, middle ear status, preoperative and postoperative audiograms, and perforation closure were reviewed. Middle ear status was represented using the Ossiculoplasty Outcome Parameter Score (OOPS). The primary outcome was perforation closure at most recent follow‐up and secondary outcomes were change in postoperative pure‐tone average (PTA) and air‐bone gap (ABG). Results: Of 48 patients, 27 underwent endoscopic underlay tympanoplasty and 21 underwent endoscopic over‐under tympanoplasty. Tragal cartilage‐perichondrium graft was used in 90% of procedures. Distribution of OOPS scores was not significantly different between groups. Over‐ under technique addressed significantly larger perforations (mean size of 54% vs. 31%, p <.001) and a higher rate of anterior extension (95% vs. 22%, p <.001) than underlay technique. Perforation closure rate was not different between groups (95% vs. 96%). Patients experienced significant improvement in PTA and ABG in both groups. Conclusion: The endoscopic over‐under tympanoplasty is comparable to endoscopic underlay tympanoplasty in terms of graft take and audiologic improvement. The over‐under technique is effective for repairing larger perforations or those with anterior extension. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Abstract Background Nasal sill is one of the components of the alar ring, affecting the esthetic outcomes of rhinoplasty; accordingly, we developed a novel technique to adjust defects in this area and compared it with the available techniques. Methods Our technique was based on creating a tunnel access to the nasal sill area through an incision made in the lower third of the columella using the open approach or through a nostril base incision in patients, who underwent alar base reduction, followed by insertion of a cartilaginous graft into the marked defect area. Results A total number of 54 patients with a defect in the nasal sill area were included in this study. Thirty-one patients underwent open rhinoplasty with the sill approach from the lower third of the columella, while 23 patients underwent rhinoplasty with a nostril base approach for nasal sill augmentation procedure. There were no reports of patient dissatisfaction, infection, bleeding, sensory dysfunction, or remaining asymmetry of the sill area. Conclusion Based on the findings of the present study, this technique can be successfully used in reconstructing the nasal sill area with minimal complications and morbidity.

The retraction pocket emergence of the tympanic membrane (eardrum) leads to the sound conduction disorder of the middle ear. Surgical removal of fixed retraction pockets leads to perforations. A cartilage grafts in the region of these perforations are installed. The aim of the study is to assess the geometric parameters of the cartilage graft, providing sound conductivity of the middle ear oscillatory system corresponding the auditory functions of the normal middle ear. The evaluation of the geometric parameters of the cartilage graft is carried out on the basis of the middle ear finite-element model. The eigenfrequencies are utilized as quantities characterizing the auditory conductivity of the middle ear oscillatory system. The thickness of the graft attached on the posterosuperior quadrant after removal of the fixed retraction pocket is 0.193 ± 0.031 mm. It is evaluated on basis of comparative analysis of the middle ear eigenfrequency spectra in normal conditions, the middle ear with attached cartilaginous grafts of different thicknesses. The obtained results can be used for planning of surgical operations to restore the integrity of the tympanic membrane and improve auditory conductivity.

Abstract Background Various grafting materials and different techniques have been used for myringoplasty. The aim of the study was to compare the result of tympanoplasty in patients with safe-type chronic suppurative otitis media using periosteum versus tragal cartilage with perichondrium grafts through pre- and postoperative clinical and audiological evaluation. Results There was statistically significant difference for mean air-bone gap for group A (23.4 dB ± 0.03 SD) when compared to group B (19.4 dB ± 4.2 SD) with P value 0.103. Also, there was statistically significant difference in the hearing gain in group A after 6 months (25.53 dB ± 6.26 SD) when compared to group B (19.63 dB ± 9.76 SD) and the P value was 0.003. Graft taken was superior in the periosteal group (95%), compared to the cartilage grafts (90%). Conclusion Tympanoplasty with periosteal graft showed better hearing results and high rates of graft taken than tragal cartilage grafts.

Objective: We compare the long-term efficacy of the cartilage–perichondrium modified over-underlay technique and transtympanic underlay alone technique using endoscopic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations. Material and methods: Nine chronic large perforations with mucosal chronic otitis media were recruited and randomly allocated to endoscopic cartilage–perichondrium modified over-underlay myringoplasty (MOUM, n = 55) and endoscopic cartilage–perichondrium transtympanic underlay alone myringoplasty (TUAM, n = 54). The graft success rate, hearing gain, mean operation time and postoperative complications were compared between the groups at 6 and 24 months. Results: In total, 99 patients were finally analysed. The graft success rates 6 months after surgery between MOUM and TUAM groups were not significantly different (100.0% vs 96.0%, p = 0.484). However, the MOUM group had a significantly higher success rate 24 months after surgery than the TUAM group (93.9% vs 76.0%, p = 0.028). In addition, postoperative ABG < 10 dB was 73.5% patients in the MOUM group and 76.0% in the TUAM group, the difference wasn't significant (p = 0.953). CT examination revealed well-pneumatised middle ears 24 months after surgery in both groups, and no middle ear cholesteatoma was observed. Conclusion: Endoscopic modified cartilage–perichondrium over-underlay myringoplasty without tympanomeatal flap elevating is reliable and effective for repairing large perforations. It improves the long-term graft success rate compared to the endoscopic cartilage–perichondrium transtympanic underlay alone technique. The risk for iatrogenic cholesteatoma is minimal. [ABSTRACT FROM AUTHOR]

Objective: To compare the graft success rates and hearing outcomes of underlay myringoplasty with or without perichondrium tucking of the attached perichondrium, graft perforation margins when repairing chronic large central dry perforations., Study Design: Randomized controlled trial., Material and Methods: Chronic large central dry perforations were prospectively randomized to tucking perichondrium graft underlay (TPGU) and no-tucking perichondrium graft underlay (NTPG) groups. The graft outcomes and complications were compared between the two groups at 12 months postoperatively., Results: In total, 61 patients with large central dry perforations were included. All patients completed 12-month follow-ups. Residual perforations occurred in 0.0 % of the TPGU group and in 12.9 % of the NTPG group (P = 0.129), and re-perforations occurred within 6 months in 0.0 % and 3.2 % of the two groups, respectively (P = 0.987). The graft success rates were 100.0 % (30/30) and 83.9 % (26/31) (P = 0.067). No significant between-group differences were observed in terms of preoperative (P = 0.547) or postoperative (P = 0.612) air bone gaps (ABGs) or mean ABG gains (P = 0.597). No graft-related complications were observed in either group during follow-up. No patients exhibited significant graft blunting or medialization; graft lateralization was noted in one patient of the NTPG group., Conclusions: Endoscopic cartilage with tucking of the attached perichondrium perforation margins during underlay myringoplasty may improve the graft success rate compared to that of the cartilage push-through technique when repairing large central dry perforations; however, the hearing improvements were comparable in the two groups., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The alar–columellar relationship is an important concept for the rhinoplasty surgeon to master. The alar rim in particular is a critical component of the nasal tip, contributing to both overall symmetry and proportion of the nasal base. The retracted ala creates a displeasing aesthetic to the tip complex, distorts the nostril openings, and may have functional implications of the external nasal valve. While alar retraction can occur naturally or as the result of trauma, the majority of cases are post-surgical in nature. Many techniques have been described for correction of alar retraction, most of which require open rhinoplasty and many fail to add the soft tissue within the vestibule necessary to properly lower the alar margin. Herein, we present our experience with the auricular chondrocutaneous composite graft—a simple, reliable, and effective technique to correct moderate to severe alar retraction via either open or endonasal rhinoplasty. [ABSTRACT FROM AUTHOR]

Background: In rhinoplasty, many techniques are used to increase the permanence of the planned final shape of the nose. Cartilage grafts can be diced and applied directly to the nasal dorsum, or by wrapping with a material. We aim to show that mixing and using diced cartilage grafts with fat grafts can contribute to the viability of cartilage grafts by comparing our early postoperative and long-term results. Materials and Methods: A total of 228 cases were analyzed. Postoperative 1-month, 6-month, and 1.5-year photographs of the patients were compared and the places that descended on the nasal dorsum were measured. In addition, dorsal height was measured and compared. Preoperative and postoperative first-year rhinoplasty outcome evaluation scales were performed. Specimens from 6 patients were examined histopathologically. Results: After the first month, the mean regression in the dorsum was measured as 1.4 mm. The decrease in dorsal height between 1 month and 6 months was significantly greater than the decrease between 6 months and late periods. According to the rhinoplasty outcome evaluation (ROE) scale, the average preoperative score of the patients was 45, while the mean postoperative score was 81.5. The viability of chondrocyte cells was measured as 85–90% histopathologically. Conclusion: This approach has been evaluated as an application that satisfies both the surgeon and the patient due to the advantages of fat grafts such as preventing the cartilage and osteotomy lines from being palpated in thin-skinned patients, holding the diced cartilage grafts together by acting as a glue, increasing the viability of cartilage grafts. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Introduction: The external auditory canal (EAC) packing is widely used in otosurgery and is considered to promote hemostasis and to support tympanic membrane grafts. However, few studies have investigated the effects of packing removal time on healing. Objective: We investigated the effect of EAC packing duration on healing after endoscopic cartilage myringoplasty in patients with chronic tympanic membrane perforations (TMPs). Materials and Methods: Patients with chronic TMPs who underwent endoscopic "push-through" cartilage myringoplasty were divided into early and late groups based on the length of time before EAC packing was removed. The graft success rate, eardrum appearance, and hearing gain were assessed 3 months after surgery. Results: The study included 137 patients. Three months after surgery, the graft success rate was 83.5% (66/79) in the early group and 94.8% (55/58) in the late group (P =.042). The graft was displaced in 8 (10.1%) patients in the early group and in 1 (1.7%) patient in the late group (P =.050). No epithelialization was found on the surface of the grafts in the early group, whereas epithelialization was nearly complete 4 weeks after surgery in the late group. Conclusions: Delaying removal of the EAC packing after endoscopic cartilage myringoplasty may promote tympanic membrane better healing and cartilage graft epithelialization and improve the appearance of the eardrum. [ABSTRACT FROM AUTHOR]

The elevation of the tympanomeatal flap in endoscopic myringoplasty will cause considerable tissue damage. To analyze anatomic and audiological results of tympanic membrane perforation underwent endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation (EPM) and their relationship with the size of perforation. A clinical retrospective study was performed on 75 cases of tympanic membrane perforation that underwent EPM from January 2019 to March 2021. Graft success and hearing outcomes were evaluated 3 months after surgery. The overall graft success rate for EPM was 94.7% (71/75). The total rate of hearing success, postoperative ABG ≤ 20 dB was achieved in 96.0% (72/75). The overall mean AC threshold of 35.1 ± 5.6 dB was lowered to 25.0 ± 4.8 dB postoperatively (p <.01). The mean pre- and postoperative ABG of all patients were 20.5 ± 4.6 dB and 10.4 ± 3.9 dB (p <.01), respectively. The graft success rates for the small, middle and large perforations groups were 100% (11/11), 100% (34/34) and 86.7% (26/30), respectively. It is revealed that EPM is an effective method to repair perforation of tympanic membrane. The size of the tympanic membrane perforation may be a risk factor for perforation healing and hearing recovery, although EPM is available for large perforations. [ABSTRACT FROM AUTHOR]

Objective:Transcanal endoscopic type 1 tympanoplasty is a minimally invasive procedure that enables better visualization of deep and narrow spaces compared to conventional microscopic methods. In our study, we aimed to evaluate air-bone gap difference, graft success, and hearing gain according to the perforation size and location in pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty.Methods:Fifty pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty for chronic otitis media were included in the study. Tragal cartilage grafts were used in all patients. Air conduction pure tone audiometry hearing results (500, 1000, 2000, and 4000 Hz), mean air-bone gap levels, operating times, postoperative gap closure, and graft success rates were evaluated.Results:Mean operating time was 43.34±8.56 minutes. Overall graft success was 94% (47/50). Mean hearing levels at all frequencies (500, 1000, 2000, and 4000 Hz) were found to have significantly improved after the operation (p