Professional Surgery Video on Ossiculoplasty with Cartilage Tympanoplasty

Ossiculoplasty with Cartilage Tympanoplasty: A Surgical Demonstration by Dr. Akbar Abbas

When a patient presents with a large central tympanic membrane perforation accompanied by ossicular chain disruption, surgical intervention becomes necessary to restore both structure and function of the middle ear. In this case, Dr. Akbar Abbas demonstrates the step-by-step management of such a challenging scenario, combining ossiculoplasty with cartilage tympanoplasty.

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🩺 Case Background

• Patient presented with a subtotal tympanic membrane perforation.
• Intraoperative findings showed incudo-stapedial joint disruption and a mobile stapes footplate.
• The ossicular chain required stabilization to restore sound transmission.

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🔍 Surgical Highlights

1. Reconstruction of the Ossicular Chain

• The incudo-stapedial joint was reconstructed using glass ionomer cement, a biocompatible material widely used in dentistry with a proven safety profile in middle ear surgery.
• Gel foam was placed on the stapes footplate to prevent accidental cement spillage and subsequent fixation.
• The cement was allowed to set for 2–3 minutes, after which ossicular chain mobility was restored.

2. Tympanoplasty with Temporalis Fascia

• A reverse tympanomeatal flap was raised for access.
• An underlay technique was employed using temporalis fascia, harvested and prepared before grafting.
• Special care was taken to tuck the fascia beneath the anterior remnant, as this is the most common site of graft failure.

3. Cartilage Reinforcement

• A cartilage graft was fashioned to size, with a notch created to accommodate the handle of the malleus.
• The cartilage was inserted endoscopically, placed snugly in the middle ear, and covered with the temporalis fascia.
• Final adjustments ensured proper positioning and stability.

4. Closure & Packing

• The reverse tympanomeatal flap was repositioned.
• Gel foam was applied around the graft for support; no canal packing was required.
• Postoperatively, the patient was prescribed antibiotics, with gel foam removal scheduled after one week.

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✅ Outcome & Clinical Significance of Ossiculoplasty with Cartilage Tympanoplasty

This combined approach of ossiculoplasty with cartilage tympanoplasty:

• Restored ossicular chain mobility.
• Provided strong structural support to the tympanic membrane.
• Enhanced long-term sound conduction and hearing recovery.
• Reduced the risk of graft failure, especially in large or subtotal perforations.

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💬 Expert Insight by Dr. Akbar Abbas

“Glass ionomer cement has proven to be safe and effective in ossicular reconstruction. When combined with cartilage tympanoplasty, it provides both mechanical stability and excellent sound transmission properties.”

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📽️ Watch the Surgical Video

See the full procedure performed by Dr. Akbar Abbas on YouTube for an inside look at modern middle ear reconstruction techniques.