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KMID : 0381219710030110753
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Journal of RIMSK
1971 Volume.3 No. 11 p.753 ~ p.762
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HEERMANN´S CARTILAGE TYMPANOPLASTY
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Abstract
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The primary purposes of the surgery of chronic supprative diseases of the middle ear are 1) safe ear, 2) dry ear, 3) conservation of hearing, There are several problems to achieve good result of tympanoplasty, such as treatment of the posterior external auditory canal and Eustachian tube, antrum plasty, obliteration of the mastoid cavity, graft material of new ear drum and reconstruction of the ossicular chain, the last two being most important factors.
The skin has been used as a graft material for the myringoplasty for a long period of time by many ear surgeons since Wullstein introduced the skin. But vein, corium, cornea, fascia, periosteum and cartilage are being used because of several complications encountered from the physiological characteristics of the skin itself.
For 10 years Heermann has been successful in utilizing the tragal cartilage not only as a columella but also in myringoplasty, and the author is to introduce this cartilage tympanoplasty method and present a few problems encountered during his own experience with this method.
The characteristics of Heermann´s tympanoplasty are as follows 1. Local anesthesia and sitting position. 2. Endaural approach.
3, Fascia and cartilage tympanoplasty.
The sitting position has the following advantages
1. Minimal bleeding
2. In stapes surgery, fragments of the foot plate are less likely to fall into the vestibule.
3. In radical ear surgery requiring the use of a drill the solution used for irrigation runs out of the operative field, even without suction.
4. The elbow of surgeon is supported for complete relaxation and the operating microscope is balanced in such a way as to enable the surgeon to make minor focusing adjustments by light pressure of his eye brows on oculars.
5. It is technically easier to rebuild the tympanic membrane out of several separated pieces.
6. Postoperatively, the transplanted fragments barely change position due to their own weight.
The cartilage bridge or plate over promontory and hypo tympanum assures the proper contact with
the stapes, prevents adhesions with the promontory and assumes the previous function of the handle
of the malleus. Cartilage chips have also been useful in the type IV tympanoplasty.
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