During tympanoplasty, the graft is placed in the 'underlay' technique. Which anatomical landmark guides correct placement of the anterior margin of the fascia graft?

• A Anterior tympanotomy wall (annulus region at 12 o'clock)
• B Tensor tympani tendon
• C Chorda tympani nerve
• D Anterior malleolar fold ✓

Explanation

In the underlay technique, the fascia graft is slipped medial to the handle of malleus; anteriorly it must be tucked deep to the anterior malleolar fold to ensure stable contact with the annulus and prevent medialization. The anterior tympanotomy wall, tensor tympani tendon, and chorda tympani serve as surgical landmarks but are not the guiding structure for anterior graft placement.

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.