A 32-year-old woman undergoes tympanoplasty for a large anterior perforation that extends up to the tympanic annulus, with almost no anterior membrane remnant present. Which grafting technique offers the most reliable support and closure in this situation?
- A Overlay graft placed lateral to the remnant and annulus ✓
- B Underlay graft placed medial to the fibrous annulus
- C Cartilage interposition between the malleus and umbo
- D Fat plug myringoplasty through the perforation
Correct answer: A. Overlay graft placed lateral to the remnant and annulus
Explanation
An overlay (lateral graft) technique is preferred when the perforation extends to the annulus with little or no anterior rim, or when a prominent anterior canal wall blocks access. The graft rests on the annulus laterally, giving stable anterior support. An underlay graft depends on an adequate anterior rim for support and tends to fall away or fail medially in this situation.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.