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7/30/2019 Cholesteatoma Part 2 Relevant Anatomy.pdf
1/3
Dr. Supreet Singh Nayyar, AFMC 2012
www.nayyarENT.com1
Cholesteatoma (Part II) Relevant Anatomy
(For more topics & presentations, visitwww.nayyarENT.com)
Folds & Ligaments of Middle Ear
Mucosal folds (Toss)
Lateral incudal fold Superior incudal fold Medial incudal fold Interossicular fold Ant malleolar fold Posterior malleolar fold Superior malleolar fold Lateral malleolar fold Tensor tympani fold Stapedial fold Obturator fold
Ligaments
Superior incudal ligament Posterior incudal ligament Ant malleolar ligament Post malleolar ligament Sup malleolar ligament
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Dr. Supreet Singh Nayyar, AFMC 2012
www.nayyarENT.com2
Development of mucosal folds
Saccus anticus Ant pouch von troltsch Supra tubal recess
Saccus medius Ant saccule Ant attic Middle saccule Sup incudal space
Prussacks space Post saccule Pars petrosa
Saccus superior Post pouch of von troltsch Inf incudal space Pyramid Post isthmus Pars squamosa
Saccus posticus Round window niche Sinus tympani Oval window
Prussacks space anatomy (Toss)
Laterally pars flaccida Medially neck of malleus Superiorly lateral malleolar fold Inferiorly lat process of malleus Anterior boundary ant malleolar fold & ligament arising from the neck of malleus Posterior boundary post malleolar fold & ligament arising from neck of malleus Connected to post pouch of von troltsch by small gap b/w post malleolar fold &
fibrous annulus
Ant isthmus b/w tensor tympani fold & ant crura of stapes
Post isthmuslocated near tip of short process of incus, b/w post incudal ligament ,
medial incudal fold, pyramid & stapedius ms.
Ant pouch von troltschb/w ant malleolar fold & tympanic membrane ant to handle of
malleus
Post pouch von troltsch b/w post malleolar fold & tympanic membrane posterior to
handle of malleus
7/30/2019 Cholesteatoma Part 2 Relevant Anatomy.pdf
3/3
Dr. Supreet Singh Nayyar, AFMC 2012
www.nayyarENT.com3
Division of posterior wall of middle ear
Types of cholesteatoma
Posterior Epitympanic cholesteatomao Originates in prussacks spaceo Lies lateral to ossicleso Go via superior incudal space to aditus & antrum (middle saccule
of saccus medius)
o Spreads to mesotympanum via posterior pouch of von troltsch ( fromwhere it goes to inf incudal space) (saccus superioris)
Posterior mesotympanic cholesteatoma (saccus posticus)o Originates in postero superior quadrant of pars tensao Lies medial to ossicleso Spreads to involve facial recess & sinus tympanio Reaches mastoid via posterior tympanic isthmus
Anterior epitympanic cholesteatoma (saccus anticus)o Formed from epitympanic retraction anterior to head of malleuso Reaches mesotympanum via ant pouch of von troltscho May involve supra tubal recesso Geniculate ganglion at risk
(For more topics & presentations, visitwww.nayyarENT.com)
pyramid
Facial
recess
Lateral
tympanic
sinus
Post
Tympanic
sinus
Sinus
Tympani
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