From the Research
Yes, you can access the middle ear with an anterior-based tympanomeatal flap. This surgical approach involves elevating the tympanic membrane along with a portion of the ear canal skin, with the flap hinged anteriorly. The anterior-based tympanomeatal flap provides good exposure to the middle ear space, particularly the posterior and inferior portions of the middle ear cavity.
Key Points
- This technique is commonly used in various otologic procedures including tympanoplasty, ossicular chain reconstruction, and certain cases of cholesteatoma removal.
- The approach works by creating an incision in the ear canal skin that extends around the posterior aspect of the tympanic membrane, allowing the surgeon to carefully elevate the drum and attached canal skin forward, thereby exposing the middle ear structures behind it.
- The anterior attachment serves as a vascular pedicle, maintaining blood supply to the flap and promoting better healing.
- However, this approach may provide somewhat limited access to the anterior middle ear space and the eustachian tube area compared to a posterior-based flap, which is an important consideration when planning middle ear surgery.
Evidence
The most recent and highest quality study on this topic is from 2019, which compared the outcomes of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty 1. The study found that the anterior-based tympanomeatal flap elevation procedure was minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.
Considerations
When deciding on the approach, it is essential to consider the location and extent of the disease, as well as the patient's individual anatomy and needs. The choice of approach should be based on the surgeon's expertise and the specific requirements of the case.
Outcomes
The outcomes of the anterior-based tympanomeatal flap approach are generally good, with high success rates and minimal complications reported in the literature 1, 2. However, as with any surgical procedure, there are potential risks and complications that need to be considered and discussed with the patient.