Endoscopic Tympanoplasty

The repair of anterior marginal tympanic membrane perforations is commonly approached through a postauricular exposure, especially in the presence of a prominent anterior bony overhang that may obscure the anterior border. Anterior perforations can be managed through a transcanal approach with endoscopic assistance to visualize the anterior mar-gin.16 Marginal perforations are conveniently repaired with a laser ''spot welding'' technique or with a cartilage ''butterfly graft.''18 The laser technique uses an argon ion or other fiber-delivered laser to reach around the bony overhang and fuse the underlay graft to the perforation margins by coagulation. The cartilage graft technique uses a cartilage-perichondrial composite graft trimmed slightly wider than the perforation margin and filleted on its edge circumferentially. The graft is then inserted into the defect like a button and the margins settle into the graft's circumferential groove.

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