Endomeatic myringoplasty with temporalis fascia

Technique by Dr. Emilio García-Ibáñez

In this case uploaded to the online surgery app SURGSCHOOL, the Dr. Emilio García-Ibáñez, pioneer of Otolaryngology and international reference in ear surgery, performs a endomeatic myringoplasty using grafting temporal fascia, in a classic video that is essential for any otolaryngologist who wants to perfect their technique.

What is endomeatic myringoplasty?

Myringoplasty is a surgical procedure intended to repair perforations of the tympanic membraneIn the endometrial variant, surgery is performed through the external auditory canal, without the need for retroauricular approaches, which allows for a faster recovery and less trauma for the patient.

Step-by-step technique according to the Dr. García-Ibáñez

1. Removal of the temporal fascia
   An incision is made in the temporal region, approximately 1-2 cm above the helix, to obtain temporalis muscle fascia. This is used as a graft material due to its biocompatibility and excellent integration.
2. Graft preparation
   The removed fascia is cleaned and smoothed on a plastic or metal surface to remove muscle adhesions. It is then cut into an oval shape, approximately twice the size of the perforated tympanic membrane.
3. Exposure of the tympanic perforation
   In the middle ear, the edges of the perforation are carefully smoothed with a double-angled instrument, ensuring a good base for graft integration. An incision is made in the skin of the ear canal, similar to that of a stapedectomy, which can be lengthened depending on the location of the perforation.
4. Advantages of the endomeatic technique
   • Simplicity and less invasiveness.
   • Fast healing, no postoperative discharge.
   • Creation of a anatomically perfect neotympanum under the anulus, avoiding retractions or cholesteatomas.
   • It does not require de-epithelialization of the tympanic membrane.
5. Graft placement
   The graft is introduced with the help of a small plate of Gelfoam, which provides rigidity and facilitates adaptation to the eardrum. It is placed beneath the remaining eardrum, ensuring close contact with the inner surface of the eardrum. The original flap is then repositioned.
6. Plugging and recovery
   A gauze packing is placed and removed after four days. In most cases, the ear requires no further care, and healing is rapid and uncomplicated.

Why watch this video on SurgSchool?

This clinical case, available in SurgSchool, is a true classic of otologic surgery. Dr. García-Ibáñez demonstrates each step of the technique in detail, with surgical commentary that reflects decades of experience. Ideal for both residents in training and specialists who wish to compare or refine their clinical practice safely, bringing the world of sound back to patients.

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