Introduction: Cartilage tympanoplasty is a surgical procedure aimed at repairing the tympanic membrane using cartilage grafts. This technique is particularly effective in cases of chronic otitis media, recurrent perforations, where traditional methods may fail. The procedure not only aims to close the perforation but also to restore hearing and reconstruct a healthy middle ear cavity. This case report presents a patient undergoing cartilage tympanoplasty placement procedure, highlighting the surgical technique.
Procedure Presentation: The cartilage tympanoplasty procedure begins with harvesting tragal cartilage, carefully preserving an anterior remnant for cosmetic purposes. The graft is measured, harvested, and trimmed to fit the tympanic membrane defect, with the perichondrium preserved on one side. A central trough is carved for seating on the malleus handle. The tympanomeatal flap is elevated, allowing placement of the graft in the middle ear cavity medial to the tympanic membrane. Crushed gel foam supports the graft, and the tympanomeatal flap is draped over it. The surgeon carefully inspects to ensure proper placement and complete perforation coverage. Additional gel foam in the canal prevents graft lateralization, completing this precise and meticulous surgical technique.
Conclusion : This case report demonstrates the effectiveness of cartilage tympanoplasty in treating chronic otitis media with tympanic membrane perforation. The use of cartilage grafts provides a robust and reliable method for tympanic membrane reconstruction, offering excellent anatomical and audiological outcomes. Further studies with larger patient cohorts are recommended to validate these findings and refine the surgical technique.
Introduction: Cartilage tympanoplasty is a surgical procedure aimed at repairing the tympanic membrane using cartilage grafts. This technique is particularly effective in cases of chronic otitis media, recurrent perforations, where traditional methods may fail. The procedure not only aims to close the perforation but also to restore hearing and reconstruct a healthy middle ear cavity. This case report presents a patient undergoing cartilage tympanoplasty placement procedure, highlighting the surgical technique.
Procedure Presentation: The cartilage tympanoplasty procedure begins with harvesting tragal cartilage, carefully preserving an anterior remnant for cosmetic purposes. The graft is measured, harvested, and trimmed to fit the tympanic membrane defect, with the perichondrium preserved on one side. A central trough is carved for seating on the malleus handle. The tympanomeatal flap is elevated, allowing placement of the graft in the middle ear cavity medial to the tympanic membrane. Crushed gel foam supports the graft, and the tympanomeatal flap is draped over it. The surgeon carefully inspects to ensure proper placement and complete perforation coverage. Additional gel foam in the canal prevents graft lateralization, completing this precise and meticulous surgical technique.
Conclusion : This case report demonstrates the effectiveness of cartilage tympanoplasty in treating chronic otitis media with tympanic membrane perforation. The use of cartilage grafts provides a robust and reliable method for tympanic membrane reconstruction, offering excellent anatomical and audiological outcomes. Further studies with larger patient cohorts are recommended to validate these findings and refine the surgical technique.
In this video, a bilateral ultrasound-guided rectus sheath nerve block is demonstrated on a 7-year-old male child undergoing umbilical hernia repair. After the induction of general anesthesia, nerve block time-out is conducted. Following this, the periumbilical area is cleansed using chlorhexidine. A high-frequency linear ultrasound probe is then placed in a transverse orientation lateral to the umbilicus to identify the rectus muscle and its posterior rectus sheath. The three lateral abdominal wall muscles—internal oblique, external oblique, and transversus abdominis—are also visualized lateral to the rectus muscle.
Using an in-plane technique, a 22-gauge, 50-millimeter-long Pajunk needle is inserted from lateral to medial direction. The needle is advanced through the subcutaneous tissue and the body of the rectus muscle until it reaches the target plane between the rectus muscle and the posterior rectus sheath. Correct needle placement is confirmed through hydro dissection with normal saline, where proper spread is indicated by separation of the rectus sheath from the muscle or by the rectus muscle lifting up.
Next, 0.2% Ropivacaine, a local anesthetic, is incrementally injected. The procedure is then repeated on the opposite side with total drug volume typically ranging from 0.05 ml/kg to 1.0 ml/kg up to a maximum total volume of 10 to 20 ml. The patient tolerates the procedure well and does not require any opioids intraoperatively or postoperatively in the post-anesthesia care unit.
In this video, a bilateral ultrasound-guided pudendal nerve block is demonstrated on a 15-month-old healthy child undergoing circumcision and penoscrotal fusion repair. After the induction of general anesthesia, a nerve block time-out is conducted. Subsequently, the patient is positioned in the frog-leg stance by an assistant, and the perineum is cleaned using chlorhexidine. Using a high-frequency linear ultrasound probe, the ischiorectal fossa is identified between the ischial tuberosity and the anus at the 3 and 9 o’clock positions relative to the anus. A 22-gauge, 50-millimeter-long Pajunk needle is then inserted using an out-of-plane technique, advanced 1-2 cm deep and medial to the ischial tuberosity, until a subtle change in resistance or “pop” is felt, confirming the correct placement below the sacrospinous ligament. The local anesthetic (0.3 to 0.5 mL/kg of 0.2% Ropivacaine or 0.25% Bupivacaine on each side) is then incrementally injected, observed as spreading medially and beneath the ischial tuberosity. The block is then repeated on the other side. Our patient tolerated the procedure well and did not require any opioids intraoperatively, postoperatively in the post-anesthesia care unit, or at home following discharge.