← All decks
ENT
Tympanoplasty Overlay Technique
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
5 sections · 80 slides
Principles and background
- Definition of overlay tympanoplasty
- Goals of tympanoplasty
- Graft plane in overlay versus underlay
- Early skin graft era
- Canal skin grafts of Sooy and House
- Introduction of temporalis fascia
- Indications for the overlay technique
- Retracted floppy tympanic membrane
- Advantages of the overlay technique
- Independence from the remnant drum
- Disadvantages of the overlay technique
- Overlay compared with underlay
Surgical technique
- Operative sequence: exposure phase
- Operative sequence: reconstruction phase
- Anaesthesia and general considerations
- Patient preparation and positioning
- Injection under the microscope
- Transmeatal canal incisions
- Inferior incision and back-elevation
- Postauricular incision
- Harvest of temporalis fascia
- Periosteal incision and mastoid exposure
- Reflecting the vascular strip
- Semilunar incision of anterior canal skin
- Elevating the ear canal skin
- De-epithelializing the remnant drum
- Aims of canaloplasty
- Canaloplasty drilling sequence
- Avoiding the temporomandibular joint
- Facial nerve risk in the posterior canal
- Diamond burr and the final medial dissection
- Anterior tympanomeatal angle after canaloplasty
- Inspecting the tympanic membrane remnant
- Middle ear work
- Preparing fascia when the malleus is present
- Preparing fascia when the malleus is absent
- Packing of the middle ear
- Placing the fascia graft
- Seating the anterior and posterior graft edges
- Covering the manubrium of the malleus
- Timing of ossicular chain reconstruction
- Replacing the ear canal skin
- Everting skin edges and free skin grafts
- Packing and closure
- Final steps of closure
Postoperative care
- Routine postoperative instructions
- Postoperative analgesia and antibiotics
- Schedule of postoperative visits
- The three-week visit
- The nine-week visit
- Baseline audiogram and the second look
Complications
- Definition and mechanism of lateralization
- Recognizing tympanic membrane lateralization
- Risk factors and treatment of lateralization
- Anterior sulcus blunting
- Functional consequences of blunting
- Prevention of anterior sulcus blunting
- Management of established blunting
- Epithelial cysts after overlay tympanoplasty
- Course and treatment of epithelial cysts
- Excessive membrane thickening
- Other causes and course of thickening
- External canal soft tissue stenosis
Outcomes and conclusions
- Measures and negative prognostic factors
- Difficulty comparing overlay with underlay
- Published overlay series
- Overlay versus underlay in published series
- Conclusions
- Key points to remember
- Origins of the main complications
- References
- References (continued)
- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
- Join our WhatsApp groups