A patient with CSOM tubotympanic type is planned for tympanoplasty. Which graft material has the advantage of providing a framework for epithelialization but is associated with the highest risk of primary graft failure due to inadequate vascularization in an underlay technique?

• A Temporalis fascia
• B Cartilage-perichondrium composite graft ✓
• C Perichondrium from tragal cartilage
• D Fat plug graft

Explanation

Cartilage-perichondrium composite grafts provide structural rigidity and resist retraction (preferred in Eustachian tube dysfunction, revision surgery), but the cartilage core is avascular and depends entirely on the perichondrial surface for vascularization. In underlay techniques, if the perichondrial surface is not adequately in contact with the vascularized middle ear mucosa, graft failure rates can be higher. Temporalis fascia is the gold standard graft with excellent vascularization and success rates of 85–95%. Fat plug is reserved for small pinhole perforations. Perichondrium alone vascularizes similarly to fascia.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.