The size and diameter of pieces of cartilage are not fixed for the palisade technique and one-piece technique
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LETTER TO THE EDITOR
The size and diameter of pieces of cartilage are not fixed for the palisade technique and one‑piece technique Yanshuang Zhu1 Received: 31 October 2020 / Accepted: 5 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, I read with great interest the article entitled: “Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study” by Larrosa et al. [1]. This authors evaluated the effectiveness of endoscopic cartilage palisade tympanoplasty compared to one-piece composite cartilageperichondrium grafts for tympanic membrane closure in adult patients with subtotal perforations and obtained similar results [1]. Although this study is well designed, I just want to declare some points that limit the power of this study. In this study, elevation of a tympanomeatal flap was performed was performed regardless of palisade technique or one-piece technique [1]. The authors described that the cartilage was placed below the tympanic membrane (TM) remnant and bony rim [1]. The cartilage graft is stiff and elastic that is easily placed trans-perforation medial to the bony rim regardless of marginal, subtotal, or total perforations (Fig. 1). As other authors said, elevation of a tympanomeatal flap is not necessary for endoscopic cartilage graft technique, it increase the intraoperative bleeding and affect the surgical fields, thereby prolong the operation time [2–6].
In addition, palisade technique and one-piece technique are not set in stone, also, including the size and diameter of pieces of cartilage. Usually, the most important prerequisite to graft success is that the appropriate size and numbers of cartilage completely close the defect. Certainly, the overlarge cartilage graft might result in the subsequent extrusion and lateralization of graft [7]. Moreover, the whole piece of free perichondrium was placed medial to the TM remnant, bony rim, and the malleus handle but lateral to the cartilage palisade or one-piece cartilage (Fig. 1). Another concern is the development of keratin pearl. We found that the keratin pearl could be developed in long term when the perichondrium was placed lateral to the malleus handle, especially in the folds area. As the author’s said, only 6-month follow-up is the limitation of this study.
This comment refers to the article available online at https://doi. org/10.1007/s00405-020-05947-3. * Yanshuang Zhu [email protected] 1
Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City 322000, Zhejiang Province, China
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European Archives of Oto-Rhino-Laryngology
Fig. 1 Left large perforation. The de-epithelialization of edges (a). Biodegradable synthetic polyurethane foam packing of middle ear (b). The first piece cartilage graft is placed trans-perforation medial to the TM remnant and bony annulus (c). The second piece cartilage graft was u
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