Bilateral Fat Graft Myringoplasty in Children Ron B. Mitchell, MD" Kevin D. Pereira, MD" Ramzi T. Younis, MDb Rande H. Lazar, MDc Memphis, Tennessee Abstract The results after simultaneous bilateral fat graft myringoplasties in children have not been previously reported in the literature. We report on 28 children who underwentbilateralfat graft myringoplasties as outpatient procedures under general anesthesia. The success rate was 1 % t final follow-up, with only 16%ofchildren requiring tnsertton of pressure-equalizing (PE) tubes following sur- gery. No complications were documented. We conclude that bilateralfat graft myringoplasties are safe to perform, with an excellent Success rate, and are suitable as outpa- tient procedures. Introduction The i eal pproach for closure of tympanic membrane perforations in children remains controversial. Although grafting of the perforation with temporalis fascia is fre- quently performed, there have been several reports of the successful use of adipose tissue from the ear lobule for closure of small unilateral perforations.':' Fat has the advantage of being easily obtained with little morbidity associated with its harvesting. Terry et al"have documented the one-year success rate of.fat graft myr ngoplasties as comparable to procedures using temporahs fascia. The procedure is technically e pedient . and can be carried out on an outpatient basis, with or without the need for intubation. Indeed, Gross et 'Pediatri.cOtolaryngology Fellow, Otolaryngology Consultants ofMem- b hI S , L eBon eur Children s Medical Cent er, Memphi s, Tenne ssee. Co-DIrector, Pedlatnc Otolaryngology Fellowship Training Program, Otol ryn gology Consultants of Memphis, LeBonheur Childrens Medical Center, Memphis, Tennessee. ' Director, Pediatric Otolaryngology Fellowship Tra ining Prog ram, Otol r yn golo gy Consultants of Memphis, LeBonheur Childrens ,Medical Center, Memph is, Tenne ssee. Repnntrequests.to: Ron B. Mitchell, MD, Oto laryngology Consultants of Memphis, LeBonheur Childrens Medical Center 777 Wash- ington Avenue , Suite P240, Memphis, TN 38105 ; Phone: 9011 821-4310; Fax: 901/821-4313. 652 al' are of the opinion that adipose plug myringoplasties produce less otologic trauma than the insertion of PE tubes and have used this procedure to repair a small perforation in one ear in patents who have had a more extensive otologic procedure in the opposite ear. The ease .and simplicity of performing a fat graft myringoplasty allows for bilateral simultaneous repair of tympanic membrane perforations; the advantages being a single anesthetic and the limited need for postoperative care, which are important in a young child. However, the literature yields little information about this cost-effec- tive procedure. We reviewed the records of 28 children who underwent bilateral fat graft tympanoplasties and . report our findings. Materials and Methods Patient Population The medical records of28 children (18 male, 10female; age range 3 to 16 years) who had undergone a bilateral adipose myringoplasty at the LeBonheurChildrens Medi- cal Center from January 1990 to December 1994 were reviewed . Patients were included in the study based on set criteria (Table 1). Active allergies, rhinosinusitis and adenotonsillitis were optimally controlled prior to the operation . The follow-up period ranged from 4 to 20 months (mean 8.5 months). The surgery was performed by fellows and attending physician staff under general anesthesia with an oral airway and a mask. The ears were prepared and draped using sterile techniques. The right ear lobule was infil- trated with 1% lidocaine with 1:100,000 epinephrine. The ears were examined under the microscope and the rim of the perforation carefully removed with a Rosen's needle and cup forceps . A small incision was made posterior to the ear lobule and a piece of fat extracted using sharp dissecting scissors. Care was taken to ensure that the graft was more than twice the size of each ENT-Ear, Nose & Throat Journ al " October 1996