Professional Documents
Culture Documents
• Pinna has two surfaces i.e. medial or cranial surface and a lateral
surface .
• Cymba concha lies between crus helix and crus antihelix. It is
an important landmark for mastoid antrum.
Anatomy of external ear
• Landmarks of pinna
Anatomy of external ear
• Bat-Ear is the most common congenital anomaly of pinna in which
antihelix has not developed and excessive conchal cartilage is
present.
• Corrections of Pinna defects are done at 6 years of age.
Ligaments and muscles of pinna
• There are both extrinsic and intrinsic ligaments and muscles.
• Extrinsic muscles are anterior, posterior and superior auricularis.
• Intrinsic muscles are helicis major and helicis minor, tragicus and anti
tragicus.
• Both groups are supplied by branches of facial nerve.
Sensory nerve supply of pinna
Lateral surface
• Upper two- third is supplied by Auriculotemporal nerve (branch of
fifth nerve).
• Lower one-third by Greater Auricular nerve (C2, C3)
Medial or Cranial surface of the pinna
• Lower two-third is supplied by Greater Auricular nerve.
• Upper one-third by the Lesser Occipital nerve.
• Arnold’s nerve (a branch of Vagus nerve) also called Alderman’s nerve
& another nerve branch of Facial nerve supplies concha on the lateral
surface of pinna.
Supply--contd
Blood supply of pinna
• Posterior auricular branch of external carotid
• Anterior auricular branch of superficial temporal artery
• A branch of occipital artery.
• Veins corresponding to the arteries drain into external jugular and
common facial vein.
Lymphatic supply
• They drain into parotid group, upper deep cervical and preauricular &
postauricular lymph nodes.
External Acoustic Meatus
• At birth only cartilaginous meatus is present because
the bony part develops from tympanic ring which is
incompletely formed at that time i.e. bony part of
meatus is absent in newborn.
• Its length is 24 mm, outer one-third (8 mm) being
cartilaginous and inner two-thirds (16 mm) bony. The
canal forms a mild S-shaped curve directed medially,
upwards and forwards and then medially, backward
and downward.
Contd----
• The canal has two constrictions in the EAC
-one, near the medial end of cartilaginous part
and the other 5 mm short of tympanic membrane
in the osseous part called isthmus.
• Floor and anterior wall of meatus are longer than the
roof and posterior part due to oblique position of
tympanic membrane .
• Anterior, inferior and posterior bony walls are formed
by tympanic part of temporal bone.
• Roof and part of posterior wall are formed by
squamous part of temporal bone.
Anatomy of external ear
• Foramen of Luschke is a deficiency in antero-inferior part
of bony meatus. It closes around 4 years of age.
• Fissures of Santorini are deficiencies seen in cartilaginous
portion of external auditory canal (EAC) through which
infection of mastoid and parotid gland can spread to the
meatus.
• Important relations include:
• Condyloid process of mandible is in close relation to
anterior wall.
• Middle cranial fossa lies above the osseous meatus.
• Mastoid air cells are posterior to it
Nerve supply of Meatus
• Anterior and superior walls comes through
Auriculotemporal branch of Mandibular nerve,
• Inferior wall
• A thin bony plate separates the middle ear from the
bulb of internal jugular vein.
• Has a small aperture for the passage of the tympanic
branch of the glossopharyngeal nerve
Walls of the middle ear
• Anterior wall
• separates the middle ear from the internal
carotid artery.
• It has
• Opening for the Eustachian tube
• Canal for chorda tympani
• Canal for tensor tympani muscle
• Anterior malleolar ligament
• Anterior tympanic artery
Walls of the middle ear
• Posterior wall
• Separates the middle ear from the mastoid process.
• It has an opening (the aditus ad antrum) which
connects the epitympanum (attic) with the mastoid
antrum.
• The stapedius muscle enters the middle ear through
this wall through a bony ridge (the pyramid).
• The vertical part of the facial nerve runs in a bony
canal in this wall.
• Sinus tympani and Facial recess
Posterior Wall
*Facial recess
• Also called Suprapyramidal recess, is a groove which lies
between pyramid and facial nerve and annulus of the
tympanic membrane, or a collection of air cells lying lateral
to facial nerve.
• The term was coined by House & Sheehy.
• It is bounded:
Medially by external genu of facial nerve
Laterally by chorda tympani
Superiorly by fossa incudis
Anterolaterally by tympanic membrane.
Contd----
• Facial recess is superficial to sinus tympani & is separated from it by
descending part of facial nerve
• Importance of this recess is
-- one can approach the middle ear from behind without disturbing
posterior meatal wall.
--This is one of the hidden areas where cholesteatoma can reoccur after
surgery,
--- Ear may continue discharging if this area is not cleared during mastoid
surgery
*Sinus Tympani
• Also called Infrapyramidal recess or medial facial recess.
• It is a depression behind promontory deep to the pyramid,
continuous with the hypotympanum & its position is
opposite to ampulla of posterior S.C.C.
• It starts at oval window and occupies a space deep to
descending part of the facial nerve and pyramid and passes
behind round window niche to hypotympanum.
**Sinus Tympani
• Sinus tympani is the most inaccessible area in the middle ear and
mastoid because posterior SCC comes in the way.
• It is also described as a triangular space between ponticulus above and
subiculum below. They are two bony spicules extending from the
promontory on to the posterior wall superiorly and inferiorly
respectively.
• Sinus tympani is bounded laterally by vertical segment of facial nerve
and medially by medial wall of tympanum.
Blood Supply Middle Ear
Mastoid bone
The mastoid air cell
system:
• Honeycomb of air
cells
• Located behind,
above and below the
ear
• Cells lined by thin
mucous membrane
The Mastoid air cells
• The largest air cell is the mastoid antrum, which lies behind the attic.
• The number and size of the other cells varies according to the degree
of cellularity.
• usually arranged in groups named after the anatomical structure they are
near to e.g. retrofacial, tip, perisinus, periantral, subdural, sinodural and
zygomatic air cells
• The mastoid process is absent in the newborn
• Forms from traction on the squamous and petrosal parts of the temporal
bone by cervical muscles, since the child starts to support his head.
• Functions of the mastoid air cells –
• Pressure-regulating mechanism of the middle ear cavity
• In decreasing the weight of the skull bones.
Mastoid bone
• Mac Ewen’s (suprameatal) triangle
• Bony surface marking of the mastoid antrum
• Boundaries
• Temporal line of supramastoid crest
• Postero-superior bony meatal wall
• Line drawn connecting the above two
• Citelli’s angle: sinodural angle
• Korner’s septum: petrosquamosal lamina
Eustachian tube or Pharyngotympanic tube
• Communicates the middle
ear cavity with the
nasopharynx
• Allows pressure to equalise
between the atmosphere
and the middle ear
• Allows mucous drainage
• Opens 1.5 cm behind the
posterior end of the inferior
turbinate
The Eustachian tube
• Length 36 mm, directed medially, forwards and downwards.
• Forming an angle of about 45 degrees with the sagittal plane and
30 to 40 degrees with the horizontal plane
• Tube is shorter, wider, and more horizontal in children
• Lateral third is bony (12mm), while its medial two thirds are
cartilaginous (24mm)
• Lined with ciliated columnar epithelium
• The tube is closed at rest
• Opens by contraction of the tensor veli palatini muscle during
swallowing and yawning to ventilate the middle ear
The Eustachian tube
• The base of the cartilaginous portion lies directly under
the mucous membrane of the nasal part of the pharynx,
and forms an elevation, the torus tubarius or cushion,
behind the pharyngeal orifice of the tube
• Fossa of Rosenmuller lies behind this end. Commonest site
for nasopharyngeal malignancy
• The diameter of the tube is not uniform throughout
• greatest at the pharyngeal orifice, least at the junction of the
bony and cartilaginous portions
• again increased toward the tympanic cavity
The Eustachian tube
• The narrowest part of the tube is termed the isthmus
• Blood supply
• Ascending pharyngeal artery
• Artery of pterygoid canal
• Venous drainage
• Pterygoid plexus
INTERNAL EAR
• It consists of a bony labyrinth contained with in the petrous temporal bone
along with the membranous labyrinth.
• Otic capsule develops from 14 centers.
Cochlear nerve
• It divides into many filaments at the modiolar base and ultimately ends
in inner hair cells (95%) and outer hair cells (5%).
• A vestibular branch of cochlear nerve supplies the vestibular end of
cochlear duct.
Vestibular nerve
• It supplies maculae of utricle, saccule and ampulla of SC ducts.
• Scarpa’s ganglion from where these fibers arise lies in the internal
acoustic meatus.
Distal to the ganglion, it divides into superior, inferior and posterior
vestibular branches.
• Superior branch supplies utricular macula and ampullary crest of
anterior and lateral SC ducts.
• Inferior branch supplies saccular macula.
• Posterior supplies ampulla of posterior SC duct.
Arteries of Labyrinth:
• Internal auditory artery is a branch of Anterior Inferior Cerebellar
Artery which itself arises from basilar artery. Internal auditory artery
(labyrinthine artery) divides into a cochlear and a vestibular branch.
• Stylomastoid branch of occipital artery and posterior auricular artery
also contribute.
• Veins:
• Cochlear vein and vestibular vein join to form the labyrinthine vein
which ends in superior petrosal sinus or in transverse sinus.
• A small vein from basal turn of cochlea also joins the internal jugular
vein.
ANY QUESTIONS ?
NO ….
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