Depending on the type of collagen the one with the closest resemblance to the tympanic membrane should be ideal. Also the type of collagen varies from centre to periphery ie. Annulus in the tympanic membrane.
Perichondrium has special advantage compared to the other 2 materials?
Perichondrium is thinner and very stable.
Temporalis fascia can be much bigger if needed.
I never used fascia lata
Temporalis fascia because of its BMR,good graft uptake results,access through same incision site if through postaural route
I used to use temporalis fascia for years but now since about 10 years I shifted to perichondrium.I found it more stable, as easy as temporalis fascia to harvest and has good take rate.
i have used tempralis fascia and tragal perichondrium extensively, as well as conchal perichondrium, periost occasionally (fascia lata is a bit far from the surgical field for easy access...) and find tragal perichondrium the best - if carefully harvested it is exactly suffcient for a subtotal or even total perforation
also it regenerates as long as the cartilage itself is not damaged and should the necessity arise it can be used again from the same sit after 8 to 12 months!
i use the transmeatal approach for all (=100%) tympanoplasties and myringoplasties
Thank you for the answers but it would be great if someone could provide documented evidence or link to studies showing advantage of perichondrium over temporalis or vice versa.
Anecdotal reports state that temporalis fascia and tragal perichondrium both are equally effective as graft materials, depending on the route of tympanoplasty (postaural vs permeatal).
Here are a few studies evaluating their role, with some stating both to be equivalent, and others suggesting that tragal perichondrium might be a better graft material (with or without use of cartilage along with the perichondrium):
http://www.iosrjournals.org/iosr-jdms/papers/Vol13-issue5/Version-3/U013538998.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431517/
http://www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_apr_oa07.pdf
http://www.jemds.com/latest-articles.php?at_id=4423
Thank you Dr Eishaan . What is the type of collagen in perichondrium alone? Ie. The tragal perichondrium?
Peri chondrites alone has type 1 collagen in its outer layer and chondrites srs in its inner later (https://books.google.si/books?id=VRWdBGTzNQgC&pg=PA178&lpg=PA178&dq=perichondrium+histology&source=bl&ots=vic-km2ELy&sig=MhVoBFOWVpLifV5uDO9OqxlBtNE&hl=en&sa=X&ei=5f2pUvGWKoT9ywOcuILoCw#v=onepage&q=perichondrium%20histology&f=false)
if if used in conjunction with a slice of travail cartilage, it has the added advantage of the relative stiffness of the cartilage which has type Ii collagen. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431517/#!po=27.1739)
the material makes no difference to the results - perichondrium is just easier to handel and place and easily accessible during transmeatal surgery
Tympanic membrane: temporalis fascia
Anterior skull base: fascia lata
Hi,
in my opinion, after 35 years of otologic surgery the best graft material is... cartilage.
they are all fine and results are similar.
i have tried these and many others (periosteum, fat, cartilage, vein)
personally i prefer tragus petichondrium for several reasons:
1. it is easily accessible in the surgical area ( i operate all middle ear surgery transmeatally)
2. there is little bleeding from removal site (temporalis fascia removal often produces awkward bleeding from one of the temporal artery branches)
3. it is firmer than temporalis fascia and retains its shape so that it is easier to place.
4 it is exactly large enough for a subtotal perforation (if you carefully remove the entire perichondrium from the posterior side of the tragus)
5. if the graft does not take ( in approximately 10-15% of all large studies) the perichondrium can be harvested again after 6 months. it regenerates fully and if you take care not to damage the cartilage it is just as easily removed.
i would be happy to send further details of the technique
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