Welcome to drtbalu's Otolaryngology online
Dr. T. Balasubramanian M.S. D.L.O.
This technique is used for repairing posterior perforations, whose margins can be clearly seen through external auditory canal.
Incision: Endaural Lempert's incision
Image showing endaural incision
The incision is 5 - 10 mm long and is performed between the tragus and crus of helix.
Tympanomeatal flap elevation and freshening of perforation margins: The skin incision for tympanomeatal flap is carried from the tympanic annulus at 7 'o clock and 12 'o clock in an ascending spiral fashion to meet the endaural incision. The anterior limb of the incision extends just anterior to the lateral process of the malleus. The edges of the perforation is freshened before elevation of the flap.
Figure showing Elevation of TM flap
After elevation of tympanomeatal flap, gelfoam pledgets soaked in Ringer's lactate is placed in the hypotympanum. Mobility of ossicular chain is checked.
Figure showing gelfoam inserted into the hypotympanum
Graft is inserted beneath the perforated drum and above the posterior tympanic sulcus.
Figure showing graft being inserted under the tympanomeatal flap.
Figure showing tympanomeatal flap replaced.