A 35-year-old patient with safe CSOM undergoes Type I tympanoplasty. The temporalis fascia graft is placed using the underlay technique. Which of the following best describes the anatomical rationale for preferring the underlay technique over overlay?

• A It allows direct visualization of the annulus during placement
• B It requires less graft material and shorter operative time
• C It provides better vascularization from the squamous epithelium
• D It avoids blunting of the anterior sulcus and reduces risk of lateralization ✓

Explanation

In the underlay technique, the graft is placed medial to the remnant tympanic membrane and annulus, which prevents blunting of the anterior sulcus (a complication of overlay technique) and reduces graft lateralization. The overlay technique places the graft lateral to the malleus handle, risking lateralization and anterior blunting. Vascularization in underlay occurs from the middle ear mucosa and remnant TM, not squamous epithelium.

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.