Blunting of the anterior sulcus is the complication most often encountered by the inexperienced surgeon. It results from excess fibrous tissue formation, especially anterior-superiorly, and when significant enough to involve the malleus handle, can reduce hearing. With severe blunting, the anterior half of the membrane assumes a concave appearance with no clear junction with the skin of the anterior canal wall
Middle Ear and Mastoid Surgery and is often immobile. The manubrium is often indistinguishable. If blunting persists for 6 months and hearing is impaired, revision tympanoplasty is required to correct it.
There are several specific steps that are taken to avoid anterior blunting. First, the entire anterior canal wall bulge is removed and the anterior angle is opened from an acute to an obtuse angle. Second, whenever possible the anterior fibrous annulus should be preserved and the fascia graft should not be placed onto the anterior canal wall bone. Third, the replaced canal wall skin should overlap the fascia graft anteriorly by 1 to 2 mm. Finally, placement of a tightly rolled, cigar-shaped piece of Gelfoam packing in the anterior sulcus to re-create the anterior angle helps prevent blunting.
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