During tympanoplasty for a large subtotal tympanic membrane perforation, the surgeon uses an underlay technique with temporalis fascia graft. Which anatomical landmark ensures the graft does not migrate anteriorly into the eustachian tube orifice?

• A Umbo of malleus
• B Anterior malleolar fold
• C Tensor tympani tendon
• D Annulus fibrosus anteriorly ✓

Explanation

In the underlay technique, the graft is tucked medial to the annulus fibrosus all around the perforation, including anteriorly, to prevent anterior migration toward the eustachian tube orifice. The annulus provides a stable circumferential ledge for graft positioning. The umbo, anterior malleolar fold, and tensor tympani tendon are not the primary landmarks that prevent anterior graft displacement.

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.