Tympanoplasty-Undersurface Graft Technique: Transcanal Approach

Chapter 11 Tympanoplasty—Undersurface Graft Technique

Transcanal Approach

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Many otologic surgeons prefer placing connective tissue grafts medial to the tympanic membrane remnant. This graft placement can be accomplished through either a transcanal or a postauricular approach. This chapter describes in detail the transcanal technique and discusses our rationale for favoring it.


In transcanal tympanoplasty using the underlay technique, the grafting material may be any type of autogenous connective tissue, such as vein, fascia, or perichondrium. In 1957, Shea,1 using vein, was the first to use the underlay grafting technique. Tabb,2 Austin and Shea,3 and others soon recognized the superiority of this method over onlay skin grafting and followed Shea’s lead. The use of fascia as an underlay graft was first reported by Storrs.4 Tragal perichondrium was first used in tympanoplasty as an onlay graft by Goodhill and associates,5 and it is the material we prefer. It is in the immediate surgical field, is extremely durable, and is very easy to handle when pressed. Vein also is easy to position and, if large enough (as from the antecubital fossa), can be used to repair perforations of any size. Our primary objection to the use of vein grafts is that in the event of a serious future illness, the large vein could be an important means of administering parenteral medications.

Temporalis fascia, its overlying areolar tissue, or even scar tissue from the vicinity of a previous postauricular incision can be used with the transcanal undersurface technique, but it is not as easy to handle as vein or perichondrium. Pressing the fascia in a vein or fascia press makes it much more manageable by eliminating the tenacious loose strands, and at the same time preventing the stiffness that occurs with drying. We do not recommend pressing the vein for tympanoplasty (as done in stapedectomy) because it results in excessive thinning. Instead, we trim away the adventitia and stretch the vessel between the blades of a vein scissors before opening it.

Jun 14, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Tympanoplasty-Undersurface Graft Technique: Transcanal Approach
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