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Cholesteatoma
(Part II)
Relevant Anatomy
Mucosal folds
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
(Toss)
Ligaments Superior incudal ligament Posterior incudal ligament Ant malleolar ligament Post malleolar ligament Sup malleolar ligament
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Saccus posticus
(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 isthmus located near tip of short process of incus, b/w post incudal ligament , medial incudal fold, pyramid & stapedius ms. Ant pouch von troltsch b/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
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Dr. Supreet Singh Nayyar, AFMC 2012 Division of posterior wall of middle ear
Post Tympanic sinus
Facial recess
Types of cholesteatoma
Posterior Epitympanic cholesteatoma o Originates in prussacks space o Lies lateral to ossicles o Go via superior incudal space to aditus & antrum (middle saccule of saccus medius) o Spreads to mesotympanum via posterior pouch of von troltsch ( from where it goes to inf incudal space) (saccus superioris) Posterior mesotympanic cholesteatoma (saccus posticus) o Originates in postero superior quadrant of pars tensa o Lies medial to ossicles o Spreads to involve facial recess & sinus tympani o Reaches mastoid via posterior tympanic isthmus Anterior epitympanic cholesteatoma (saccus anticus) o Formed from epitympanic retraction anterior to head of malleus o Reaches mesotympanum via ant pouch of von troltsch o May involve supra tubal recess o Geniculate ganglion at risk
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