Which type of tympanic membrane perforation is the classic indication for placing the temporalis fascia graft using the overlay (lateral graft) technique rather than the underlay technique?

• A Small central perforation with an adequate residual rim
• B Perforation with an intact ossicular chain and dry ear
• C Marginal perforation with cholesteatoma
• D Subtotal or anterior perforation with a prominent anterior canal wall bulge ✓

Explanation

The overlay technique places the graft lateral to the fibrous annulus onto the annular sulcus, so it is preferred for subtotal or large anterior perforations where an underlay graft would be unstable against a bulging anterior canal wall and risks blunting of the anterior angle. Small central perforations with a residual rim are ideal for underlay placement, which avoids the lateralization and blunting complications of overlay grafts.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.