Tympanoplasty
Definition: operation involving tympanic membrane and evaluation of middle ear
Whereas myringoplasty is an operation of the tympanic membrane
Tympanoplasty can be accompanied with or without mastoidectomy

Types of Tympanoplasty
Type I: restoration of normal ME with intact ossicles
Type II: Ossicular chain partially destroyed but preserved ad continuity restored
Type III: TM lays on stapes suprastructure
Type IV: Round window protection with a small middle ear mobile footplate left exposed
Type V: Closed middle ear with round window protection; fenestra in the horizontal semicircular canal coveredby a skin graft.

Middle Ear Anatomy
Ossicles: Malleus, Incus, Stapes
Ligaments: sup malleolar ligament, stapedial tendon
Cochlearform process, pyramidal process

Technique
Evaluate TM and ME if perforation present
Create vascular strip
Incise postauricular incision for mastoidectomy
Mastoidectomy- identify lateral landmarks for drilling. Anterior boundary-post EAC, superior boundary- root of the zygoma, linea temporalis, inferior boundary- mastoid tip.  Drill medially and saucerize, delineating Tegmen superiorly, thinning post EAC anteriorly, Sigmoid sinus posteriorly, Horizontal SCC medially
Identify vertical segment of facial nerve between HSCC and digastric ridge
Open facial recess: boundaries are fossa incudus, facial nerve, chorda tympani
Visualization of incus, malleus in antrum, incus and stapes in facial recess.
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