 Hi, I am Dr. Shankar from Smriti ENT Centre, Bangalore. In this surgical video, I am demonstrating single-handed endoscopic tympanoplasty and a subdental perforation with extra resolution of hand of Malleus with details of Midlian anatomy. Here you can see the freshening of the margins using a combination of curved tip and round knife and the circular knife. This is a tympanometal incision followed by a tympanometal flap. Elevation up to that annulus, the incision being given from 3 o'clock up to 5 o'clock. Now in this step, you can see entering into the midlian with elevation of the tympanometal flap, dissection of the card of tympanine nerve, identification, preservation and dissection. Now the annulus is being elevated. The handle of Malleus being skeletonized right from the notch of rivenus along the neck lateral process till the tip of the handle of Malleus. Elevation of tympanometal flap is completed. Up to the incision. This is prominent tympanose formus suture line. This is a tympanomastoid suture line. The notch of rivenus, the anterior bony annulus where the flap is already elevated with the station tube opening. You can see there. This is the bony annulus which launches the fibrosanus of the tympanic membrane. The edematous mucosa over the incidustipitial joint is being cleared. A bit of details of midlian anatomy. Round window membrane launched within the round window niche. Cromontary that is ponticulus. A ridge of bone going from the cromontary till the pyramid. It is very clearly seen in this case. The sinus tympani area. That is the sinus tympani area. Boundary inferiorly by subiculum and superiorly by the ponticulus. That is hypotiphanic cells. High type to show. And this is ocicular moment. Intact ocicles and mobile. Station tube opening. Now this is the hypotiphanic cells. Sometimes we can find high ocular valve and sometimes it may be dehiscent also. This is the Jacobson nerve which is a branch of glasopharyngeal nerve which supplies the mucosa of the midlian. Jacobson nerve is very clearly seen. This is a complete panoramic view of the endoscopic anatomy of the midlian. Now preparation for the grafting. Middle ear is filled with gel foam. Already harvested temporalis fascia being placed exteriorization of the handle of the lunges with double breasting. As you can see the graft of the fascia duct is covering nicely all the photons of the bony canal and covering the blood pressure. This is the double breasting of the temporalis fascia graft. Now the flap is being repositioned. This is the final picture where the graft is nicely sealed in the perforation. Gel foam being placed in the external auditory canal to keep the tympanomenon flap in position. This is the end of the search. Thank you for watching the video.