During tympanoplasty, the surgeon uses an underlay technique with temporalis fascia graft. At 3-month follow-up the graft appears blunted anteriorly at the tympanomeatal angle. Which intraoperative step best prevents this anterior blunting?
- A Making a larger anterior tympanomeatal flap and ensuring graft contact with the anterior canal wall ✓
- B Placing the graft medial to the malleus handle
- C Using cartilage instead of fascia for the graft
- D Applying Gelfoam anterior to the annulus
Correct answer: A. Making a larger anterior tympanomeatal flap and ensuring graft contact with the anterior canal wall
Explanation
Anterior blunting (anterior canal wall adhesion to the graft) is prevented by making a larger anterior tympanomeatal flap, ensuring the graft extends well anteriorly and contacts the anterior canal wall, maintaining the tympanomeatal angle. Placing graft medial to the handle addresses a different technique variant. Cartilage reduces perforation recurrence but does not specifically prevent blunting. Gelfoam packing helps support the graft but is not the primary preventive step.
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.