Optimal Anatomical Location for Initiating Fibrous Layer Separation During Interlay Myringoplasty

Abstract

This narrative review addresses the optimal anatomical location for initiating fibrous layer separation from the mucosal layer during interlay myringoplasty to minimize tissue damage and improve surgical outcomes. A comprehensive literature search performed on PubMed identified ten clinical studies meeting eligibility criteria, primarily focusing on the anterior or anteroinferior annulus as the optimal site for fibrous layer separation. Closure rates ranged from 88% to 100%, with studies reporting up to 98.3% success when initiating separation at the anteroinferior annulus. Graft uptake rates varied from 88% to 100%, with postoperative air-bone gap improvements generally reducing preoperative values (up to 36.4±12.0 dB) to below 16 dB. Few complications were noted, including 5.3% pearl formation and 6% inclusion cholesteatoma in specific cases. The surgical approach was predominantly postauricular, supplemented by endoscopic approaches in pediatric and difficult cases. Technical variations included diverse instruments for layer separation and multiple graft materials. The evidence suggests that starting separation at the annulus minimizes mucosal disruption while supporting rapid epithelialization and robust healing. However, inconsistent reporting of outcomes and variable follow-up durations highlight the need for standardized protocols in future research. This review reinforces the significance of anatomical precision in interlay myringoplasty and underscores existing gaps in the literature for further exploration.

Keywords: Myringoplasty, Tympanoplasty, Ear Surgery, Tympanic Membrane Perforation, Surgical Outcome