Temporalis fascia size
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temporalis fascia graft size dimensions tympanoplasty harvesting
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I now have sufficient information from both textbooks and clinical sources. Here is a comprehensive answer:
Temporalis Fascia - Size and Harvesting
Typical Graft Size
The temporalis fascia graft is generally harvested to measure approximately:
| Context | Size |
|---|---|
| Standard tympanoplasty / myringoplasty | ~2.5 x 1.5 cm (loose areolar fascia, pressed and dried) |
| General tympanoplasty use | 3 x 3 cm to 4 x 4 cm (true deep temporalis fascia) |
| Translabyrinthine closure (dural defect) | 4 x 4 cm piece |
| Congenital aural atresia repair | Sized to drape 2-3 mm beyond the edges of the defect in all directions |
- In practice, the graft is cut slightly larger than the perforation, because it shrinks by approximately 20-25% during drying under a heat lamp.
- Once placed, the fascia edges are reflected up onto the bony canal wall by about 1-2 mm in all directions (Shambaugh).
Harvesting Technique
- Incision site: A small incision is made posterosuperior to the helix in the hair-bearing scalp (for transcanal approach), or via superior dissection from a post-auricular/endaural incision.
- Plane: The fascia is elevated off the underlying temporalis muscle using a Freer elevator and scissors. Getting into the correct plane minimizes bleeding.
- Post-harvest: The graft is pressed and dried (under a heat lamp or between gauze), then trimmed to the desired shape on a Teflon block.
Anatomical Note
There are two layers to be aware of:
- Deep temporalis fascia - the true temporalis fascia, tough and commonly used
- Loose areolar fascia ("fool's fascia") overlying it - more pliable, lies in an avascular plane (minimal bleeding), and considered by some surgeons superior for handling; it is often preferred for primary cases, with true fascia saved for revisions
Clinical Points
- Temporalis fascia is the most commonly used autologous graft for tympanic membrane repair (introduced in the early 1960s) - Cummings Otolaryngology, p. 2728
- It does not resorb significantly in vivo, and donor site morbidity is minimal
- For perforations >50%, cartilage grafts are increasingly preferred (meta-analyses show 92% vs. 82% success rate for cartilage vs. fascia)
- If temporalis fascia is unavailable (e.g., multiple revisions), alternatives include: perichondrium, fat, periosteum, AlloDerm, or bovine pericardium
Sources: Cummings Otolaryngology Head and Neck Surgery; Shambaugh Surgery of the Ear; Stanford Oto Surgery Atlas
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