Abstract
Tragal cartilage graft tympanoplasty was performed on 23 ears in which previous tympanoplasties or radical mastoidectomy had been unsuccessful. The operation was limited to ears having an aerated cavity around the Eustachian tube orifice and the patent tube. There was granulation tissue with or without cholesteatoma in the athelectatic posterior half of the tympanic cavity and the mastoid. After re-exploring the mastoid cavity, all the residual air cells were eradicated using a diamond bur, and white healthy cortical bone was exposed in all dimensions of the cavity. Pathology around the stapes was cleared but the mucosa in the tympanic cavity remained untouched. The facial buttress and the bony posterior ear canal were lowered as much as possible. If superstructure of the stapes was missing, the cartilage prosthesis was placed on the footplate. The tragal cartilage was fashioned to fit the tympanic annulus anteriorly and the facial canal posteriorly and was placed to seal the tympanic cavity exactly. In five ears, the mastoid cavity was obliterated by an anterior pedicle temporalis muscle flap. The follow-up study from one to seven years confirmed that the smoothly surfaced mastoid cavity dried perfectly in all ears. There was neither adhesion nor a retraction pocket. Epithelial debris or crust was scanty. In 13 ears, postoperative hearing remained within 30dB, and in 8 ears it improved more than 15dB. In two ears, hearing deteriorated more than 15dB postoperatively. Our experiences have proved that the use of the tragal cartilage is beneficial for recostruction of the middle ear in selected cases in which reoperation was required and its advantages are; (1) accessibility in the operative site, (2) availability in an adequate amount, (3) excellent contour and thickness, (4) adequate stiffness and elasticity, and (5) excellent survival capacity without producing tissue reaction and adhesion.
