Imaging Examination of a Three-Year Follow-up of Cartilage Underlay Myringoplasty with Preserving Perforation Margins for Repairing Small- to Medium-Size Perforation.

ImportanceTrimming perforation margins (TFMs) is a classic procedure of myringoplasty.ObjectiveThe objective of this study was to evaluate the long-term graft outcomes and iatrogenic cholesteatoma of endoscopic cartilage myringoplasty with preserving perforation margins (PFMs) for repairing small- to medium-size perforation.Study designProspective semi-randomly control study.SettingTertiary university hospital.ParticipantsPatients with chronic small- to medium-size perforations.InterventionTFM group or the PFM group.Main outcome measuresComprehensive evaluations included graft success rate, hearing improvement, and imaging examinations at 3, 6, and 36 months after surgery and complications.ResultsAt postoperative 3 months, the graft success rate was 91.84% in the TFM group and 96.30% in the PFM group (P = .59). At postoperative 6 months, graft separation resulted in re-perforation in 3.70% patients in the PFM group, and the graft success rate was 91.84% in the TFM group and 92.59% in the PFM group (P = .82). At postoperative 3 years, the graft success rate was 93.88% in the TFM group and 94.44% in the PFM group (P = .77). Although postoperative air bone gaps (ABGs) were not significantly different between 2 groups, the PFM group had better hearing restoration compared with the TFM group in postoperative 3 months or 3 years. Additionally, although no significant differences were found in the ABGs between postoperative 3 months and postoperative 3 years in any group, postoperative 3 years showed better hearing restoration compared with postoperative 3 months. In addition, endoscopic morphology showed the graft stratification in .00% in the TFM group and 11.11% in the PFM group (P = .05). Postoperative high-resolution computed tomography (HRCT) revealed a few soft tissue shadow in 8.16% patients in the TFM group and in 5.56% patients in the PFM group (P = .89); middle ear cholesteatoma was excluded by magnetic resonance imaging. However, HRCT revealed that the middle ear and mastoid were well pneumatized in the remaining patients.Conclusions and relevanceThe long-term graft success rate and hearing improvement of cartilage underlay myringoplasty with PFMs are reliable for repairing small- to medium-size perforations; 3 years imaging examinations did not reveal iatrogenic cholesteatoma. However, it may cause graft stratification and graft separation.