Learning Objectives:

Introduction: Reconstruction of anterior or subtotal tympanic membrane perforation is challenging. The objectives of this study are to describe a medio-lateral graft tympanoplasty technique and use of anterior canal skin for reconstruction of anterior or subtotal tympanic membrane (TM) perforation and to analyze 20 years of experience using this graft method.

Method: This is a retrospective study of 400 patients who underwent the medio-lateral graft tympanoplasty for reconstruction of anterior or subtotal TM perforation during the past twenty years. The main outcome measure was intact TM. In this method temporalis fascia or perichondrium is grafted medial to posterior TM, malleus handle and posterior half of the perforation and lateral to anterior half of the de-epithelialized TM perforation up to the annulus. Anterior canal skin is rotated as superiorly based flap to cover fascia graft and TM perforation as a second layer closure. Outcome was considered successful if TM is intact.

Results: There were twelve failures (97% success rate) due to a postoperative infection, anterior blunting, or recurrent cholesteatoma.

Conclusion: The medio-lateral graft method is superior to the traditional medial or lateral graft technique for the large anterior or subtotal TM perforation taking advantage of both medial and lateral grafting method while avoiding their pitfalls.