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Hyaluronic acid fat graft myringoplasty: how we do it.

Saliba I - Clin Otolaryngol (2008)

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (Pavillon Hôtel Dieu), Montreal University, Montreal, QC, Canada. issam.saliba@umontreal.ca

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Dear Editor, Tympanic membrane (TM) perforation is most commonly a result of infection, trauma, or the sequelae of tympanostomy tube insertion... Although 88% of traumatic perforations of any size heal without intervention, the remainders become chronic and require treatment... Without closure, morbidity may include hearing loss, chronic otorrhea and cholesteatoma formation... There were nine right ears and 12 left ears... Global successful closure of the perforation was observed in 17 of 21 patients (81%)... Closure rates of the perforation in group I, II, III and IV were 75%, 78%, 83% and 100% respectively... The procedures were well tolerated by all patients without major side effects or complications... Perforations, in his series, are 5–30% of the drum surface, which would be a good prognostic factor for a fat graft myringoplasty whereas larger perforation are less successful with fat graft alone... Prior et al. conclude that repair of tympanic membrane perforations with hyaluronic acid ester films alone is not to be recommended... In the spontaneous healing phenomenon of tympanic membrane perforation, there is a continuous centrifugal migration of the outer squamous epithelial layer; it is missing supportive matrix under the regenerating epithelial layer of a perforation, preventing the influx of reparative cells and nutrients into the area of healing... An excessive pressure on the HA epidisc by the lateral gelfoam dressing should be avoided; it could block the epithelial migration... In the two unsuccessful cases of group II, the anterior wall of the external auditory canal presents a posterior bulging and prevents a complete identification of the perforation’s anterior rim resulting to an incomplete contact between the tympanic membrane remnant and the fat graft, and to a partial adherence between the tympanic membrane remnant and the HA epidisc... The closure rate of the perforation in group II becomes 100%... These pieces of gelfoam are important to prevent medialization of the fat graft... Air–bone gap improvement for the operated ears was 17 dB and it is clinically significant.

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Right ear. (a) Central large perforation. (b) 2 months post hyaluronic acid fat graft myringoplasty. We notice the neovascularization of the new epithelium developed on the fat graft.
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fig03: Right ear. (a) Central large perforation. (b) 2 months post hyaluronic acid fat graft myringoplasty. We notice the neovascularization of the new epithelium developed on the fat graft.

Mentions: There were 13 females and eight males with the age range of 16–80 years (mean age 53.6 years). No patient had a bilateral perforation. There were nine right ears and 12 left ears. Global successful closure of the perforation was observed in 17 of 21 patients (81%). Closure rates of the perforation in group I, II, III and IV were 75%, 78%, 83% and 100% respectively. The procedures were well tolerated by all patients without major side effects or complications. There were four unsuccessful repairs of tympanic membranes of which two belong to a postoperative graft infection and two belong to an anatomic factor. In these later cases, the anterior wall of the external auditory canal presents a posterior bulging and prevents a complete identification of the perforation’s anterior rim. One patient in the group IV necessitates two procedures at 2 months interval. After the first intervention, this total perforation was closed by 80%. Total healing occurred after the second procedure. The follow-up ranged from 4 to 16 months with a mean time follow-up of 11 months. The fat graft loses 50% of its bulging at the postoperative second month (Fig. 3) and the remaining loses 45% at the postoperative fourth month. At 6-month postoperatively, we find a small stain of the fat graft in the tympanic membrane thickness. The mean preoperative air-bone gap was 22 dB. The mean air–bone gap improvement for the operated ears was 17 dB (Table 2). The mean time of the procedure is 10 min.


Hyaluronic acid fat graft myringoplasty: how we do it.

Saliba I - Clin Otolaryngol (2008)

Right ear. (a) Central large perforation. (b) 2 months post hyaluronic acid fat graft myringoplasty. We notice the neovascularization of the new epithelium developed on the fat graft.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2691897&req=5

fig03: Right ear. (a) Central large perforation. (b) 2 months post hyaluronic acid fat graft myringoplasty. We notice the neovascularization of the new epithelium developed on the fat graft.
Mentions: There were 13 females and eight males with the age range of 16–80 years (mean age 53.6 years). No patient had a bilateral perforation. There were nine right ears and 12 left ears. Global successful closure of the perforation was observed in 17 of 21 patients (81%). Closure rates of the perforation in group I, II, III and IV were 75%, 78%, 83% and 100% respectively. The procedures were well tolerated by all patients without major side effects or complications. There were four unsuccessful repairs of tympanic membranes of which two belong to a postoperative graft infection and two belong to an anatomic factor. In these later cases, the anterior wall of the external auditory canal presents a posterior bulging and prevents a complete identification of the perforation’s anterior rim. One patient in the group IV necessitates two procedures at 2 months interval. After the first intervention, this total perforation was closed by 80%. Total healing occurred after the second procedure. The follow-up ranged from 4 to 16 months with a mean time follow-up of 11 months. The fat graft loses 50% of its bulging at the postoperative second month (Fig. 3) and the remaining loses 45% at the postoperative fourth month. At 6-month postoperatively, we find a small stain of the fat graft in the tympanic membrane thickness. The mean preoperative air-bone gap was 22 dB. The mean air–bone gap improvement for the operated ears was 17 dB (Table 2). The mean time of the procedure is 10 min.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (Pavillon Hôtel Dieu), Montreal University, Montreal, QC, Canada. issam.saliba@umontreal.ca

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, Tympanic membrane (TM) perforation is most commonly a result of infection, trauma, or the sequelae of tympanostomy tube insertion... Although 88% of traumatic perforations of any size heal without intervention, the remainders become chronic and require treatment... Without closure, morbidity may include hearing loss, chronic otorrhea and cholesteatoma formation... There were nine right ears and 12 left ears... Global successful closure of the perforation was observed in 17 of 21 patients (81%)... Closure rates of the perforation in group I, II, III and IV were 75%, 78%, 83% and 100% respectively... The procedures were well tolerated by all patients without major side effects or complications... Perforations, in his series, are 5–30% of the drum surface, which would be a good prognostic factor for a fat graft myringoplasty whereas larger perforation are less successful with fat graft alone... Prior et al. conclude that repair of tympanic membrane perforations with hyaluronic acid ester films alone is not to be recommended... In the spontaneous healing phenomenon of tympanic membrane perforation, there is a continuous centrifugal migration of the outer squamous epithelial layer; it is missing supportive matrix under the regenerating epithelial layer of a perforation, preventing the influx of reparative cells and nutrients into the area of healing... An excessive pressure on the HA epidisc by the lateral gelfoam dressing should be avoided; it could block the epithelial migration... In the two unsuccessful cases of group II, the anterior wall of the external auditory canal presents a posterior bulging and prevents a complete identification of the perforation’s anterior rim resulting to an incomplete contact between the tympanic membrane remnant and the fat graft, and to a partial adherence between the tympanic membrane remnant and the HA epidisc... The closure rate of the perforation in group II becomes 100%... These pieces of gelfoam are important to prevent medialization of the fat graft... Air–bone gap improvement for the operated ears was 17 dB and it is clinically significant.

Show MeSH
Related in: MedlinePlus