الفهرس 
Aim of StudyOnly 14 pages are availabe for public view
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Abstract
One of the common sequelae of chronic otitis media is tympanic membrane (TM) perforation, which can cause hearing loss and otorrhea. It is essential for every otolaryngologist to know how to repair tympanic membrane perforation.
The 2 classic methods for reconstruction of TM perforation have been medial (underlay) or lateral (overlay) graft technique.
In the underlay technique, the graft is placed entirely medially to the remaining TM and malleus while In the overlay technique, the graft is placed laterally to the annulus, and any remaining fibrous middle layer after the squamous layer has been carefully removed , Each of these techniques has its advantages and disadvantages. (Kartush et al, 2002)
The anterior TM perforation is difficult to repair because of less vascularity than posterior tympanic membrane and the anterior bony overhang that locks visualization. Because of reduced vascularity in the anterior tympanic membrane, there is a greater risk of necrosis and reabsorption of the fascia graft. (Richard et al, 2006)
When the medial graft technique is used to repair anterior or subtotal TM perforation, the anterior portion of the fascia graft may fall away, resulting in reperforation and obliteration of anterior part of middle ear cavity Although the lateral graft technique has a higher success rate for the reconstruction of anterior or subtotal TM perforation, serious lateralization of graft may occur. These problems have been managed by a variety of surgical techniques, such as the use of sandwich graft tympanoplasty, over– under tympanoplasty, and so on. Yet, a still better method is needed to repair anterior perforation, (Timothy et al, 2009).