Description: A lateral graft tympanoplasty is performed to demonstrate the utility of this technically challenging approach. The technical pearls that contribute to the high success rate of this graft are highlighted.
Learning Points: The lateral graft tympanoplasty was popularized by Sheehy in the 1960s. Although technically more demanding than underlay graft techniques, the lateral graft is an essential method for Otologists to have in their armamentarium. The lateral graft is especially useful in cases of total perforation or anterior marginal perforation as well as revision tympanoplasty. Potential disadvantages of this technique include graft lateralization and anterior blunting as well as keratin pearl formation. When performed by an experienced surgeon, the results of lateral grafting are excellent. The technical considerations that promote successful lateral grafting are highlighted in this video.
Lateral Graft Tympanoplasty
Lateral graft tympanoplasty is a potent technique in Otolaryngology that can be used to address the full range of tympanic membrane perforations. It is commonly employed for large tympanic membrane perforations, anterior marginal perforations and revision tympanoplasty.
Contraindications to the lateral graft technique are similar to those of the medial graft technique and include active middle ear infection.
Setup should include a standard tympanoplasty tray as well as a balanced, sterile microscope.
Pre-operative workup includes a thorough history and physical examination. A formal audiogram should be obtained on all patients to document pre-operative hearing prior to surgery.
Pertinent anatomy includes the anatomy of the tympanic membrane, which is composed of an outer keratinizing squamous layer, middle fibrous and inner mucosal layer. The blood supply to the inner surface of the tympanic membrane is from the anterior tympanic artery and the outer surface is from the deep auricular artery.
The lateral graft technique has the advantage of being applicable to any size and location of tympanic membrane perforation. In experience hands, the lateral graft technique offers excellent and reliable results. The primary disadvantage of this technique is that it is technically more challenging and more time consuming than a medial graft.
Potential risks of the operation include graft failure with persistent perforation, blunting at the anterior sulcus, lateralization of the graft, facial nerve injury, iatrogenic cholesteatoma, vertigo and dysgeusia,
House, W. F., & Sheehy, J. L. (1961). Myringoplasty: use of ear canal skin compared with other techniques. Archives of Otolaryngology, 73(4), 407-415.
House, H. P. (1953). XCIII Surgical Repair of the Perforated Ear Drum. Annals of Otology, Rhinology & Laryngology, 62(4), 1072-1082.