Fig. 2

Diagram of the marginal perforations involving the malleus. Tympanic membrane perforation (a); the perforation edges were refreshed and annulus was de-epithelialized, a small rim of EAC was removed (b); the lateral perichondrium was lifted off of the superior and inferior end, a notch was made for the malleus (c and d); the cartilage graft was placed medial to the remnant TM and the annulus, a notch of cartilage was clipped into the malleus, the free perichondrium was placed lateral to the malleus, the annulus and exposed EAC (e). TM: tympanic membrane; TMP: tympanic membrane perforation; EAC: external auditory canal; MA: malleus handle; PE: perichondrium; CA: cartilage; CAP: cartilage with perichondrium. The black shadow region indicates the excision of a small rim of EAC. Red dotted line indicates the fresh perforation edges. The section E: Black hidden line indicated the underlay cartilage. Pink shadow indicates the overlay perichondrium