A 35-year-old patient with a central tympanic membrane perforation and intact ossicular chain undergoes type I tympanoplasty. Intraoperatively, the anterior canal wall is found to be overhanging, limiting graft placement. Which grafting technique is most appropriate in this situation?

• A Underlay technique using temporalis fascia
• B Overlay technique using split-thickness skin ✓
• C Underlay technique using perichondrium
• D Inlay butterfly technique using cartilage

Explanation

When the anterior canal wall is overhanging and limits access for underlay graft placement, the overlay (lateral graft) technique is preferred because the graft is placed superficial to the annulus and remnant TM, allowing good anterior placement without needing to undercut beneath the overhanging wall. The underlay technique requires adequate anterior annular remnant and visualization, which is compromised here. The butterfly/inlay technique is used for small central perforations and is not suited for large perforations with access difficulties.

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.