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Dr.

Supreet Singh Nayyar, AFMC 2012

Cholesteatoma

(Part II)

Relevant Anatomy

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Folds & Ligaments of Middle Ear

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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Dr. Supreet Singh Nayyar, AFMC 2012 Development of mucosal folds


Saccus anticus Saccus medius Ant saccule Middle saccule Post saccule Saccus superior Ant pouch von troltsch Supra tubal recess Ant attic Sup incudal space Prussacks space Pars petrosa Post pouch of von troltsch Inf incudal space Pyramid Post isthmus Pars squamosa Round window niche Sinus tympani Oval window

Saccus posticus

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 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

pyramid Sinus Tympani

Lateral tympanic sinus

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

(For more topics & presentations, visit www.nayyarENT.com)

www.nayyarENT.com

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