A 32-year-old woman has a subtotal tympanic membrane perforation extending to the annulus anteriorly. The anterior canal wall shows a prominent bony overhang that obscures the anterior drum margin. Which grafting technique gives her the best chance of an intact neotympanum?

• A Underlay graft placed medial to the remnant
• B Fat plug myringoplasty
• C Cartilage island graft wedged between malleus handle and annulus
• D Overlay graft placed lateral to the annulus on the canal wall ✓

Explanation

An overlay technique places the graft lateral to the annulus and over the bony canal wall, so it supports a graft when no drum rim exists anteriorly and when the anterior canal wall bulge prevents reliable medial placement. An underlay graft in such an ear tends to fall away or detach anteriorly, causing persistent perforation. Fat plug myringoplasty suits only small central perforations, and cartilage is chosen for retraction disease, not absent anterior margins.

Reference: Cummings Otolaryngology Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.