INTRICACIES OF MIDDLE

EAR AND MASTOID

Dr N D Zingade
“The danger to the patient of an incompetent
operator, who does not know the many
anatomical details crowded together in the
narrow space of the temporal bone and their
extreme variability, is much greater here than
in any other region of the body”

Textbook of Otology
 Middle ear cavity (tympanum)
 Box with four walls, a roof and a floor
 Air filled space within the temporal bone
 Three ossicles
 Two muscles
 Nerves
 Vessels
 Epitympanum

 Medial wall : LSC and SSC ampullae

Tympanic portion of facial n
 Structures : Head and neck of malleus
Body of incus
Short pro and part of long pro of incus
 Mesotympanum

 Medial wall : Tympanic portion of facial n

RWN

 Structures : OW, RW, Stapes, Stapedius m,

canal for tensor tympani m

 Hypotympanum

 Inferior to ETO and RWN

 Structures : Bony trabeculae

Bony covering of J B
 Lateral wall
 Tympanic membrane
 Outer attic wall (Scutum of Leidy)
 Three openings in the bone of the medial
surface of the lateral wall:
Posterior canaliculus for chorda tympani n

Petrotympanic (Glasserian) fissure

Canal of Huguier
 Roof

 Petrous portion of temporal bone

 Squamous portion of the temporal bone

 Petrosquamous suture: unossified in the

young and does not close until adult life

 Floor
 Narrower than the roof
 Jugular bulb
 May be deficient
 Junction of floor and the medial wall : inferior
tympanic canaliculus for Jacobson’s n
 Anterior wall
 Lower III : Thin plate of bone covering CA
Perforated by sup and inf caroticotympanic
n carrying symp fibres to tymp plexus
 Middle III : Canal for tensor tymp m
ETO
 Upper III : Pneumatized
ant epitympanic sinus
 Medial wall
 Promontory
 Oval window (fenestra vestibuli)
3.25mm x 1.75mm
 Horizontal portion of facial n : Pro coch
 Round window (fenestra cochleae)
1.8 – 2.3mm
 Ponticulus and subiculum
Posterior Tympanum
Highest incidence of retractions &
cholesteatomas : difficult to remove

 Facial sinus
 Posterior tympanic sinus
 Lateral tympanic sinus
 Sinus tympani – the largest
 Posterior wall
 Wider above
aditus–ad–antrum
Fossa incudis
Pyramid
Facial recess
chordo facial angle leads to M E C
( Facial recess approach )
 Contents of M E C
 Air
 Ossicular assembly
I M Jt – Saddle art
I S Jt - Ball & Socket art
 Malleus : 7. 5 – 9 mm
Head, Neck, 3 processes
Ant & sup lig
 Incus : Body, 2 processes

long pro precarious bl sup

lentiform pro – ? IV ossicle

 Stapes : Head, Neck, 2 crurae,

base(foot plate) : 3mm x1.4mm

 Muscles

 Tensor tympani

N S – med pte n (mand n)

 Stapedius

N S – facial n

Protection/Augmentation/Stabilization
 Nerves

Chorda tympani

 branch of VII n

 post can- ant can( Glasserian fissure )

 ant 2/3 tongue – taste

Cont...

Tympanic plexus
 Over the promontary
 Jacobson’s n + Carotico tympanic n
 Supplies mm of MEC
 GSPN
 LSPN
 Compartments
 Sup mal fold - Ant mal space
 Sup inc fold - Sup inc space
Med inc space
 Mesotymp - Inf inc space
Ant pouch of Von Troltsch
Post pouch of Von Troltsch
 Prussac’s space
 Mastoid antrum
 14 mm :
 9 mm :
 7 mm :
 Ant : a-a-a
 Med : P S C, L S C
 Lat : squ temp
 Roof : teg antri
 Post & Floor : mastoid portion
 Suprameatal spine

Anson and Donaldson

 Variant I : SMS - small, smooth

EAC - vertical

SP - short

 Variant II : SMS - short elongated crest

EAC - ant wall(thin) bulge

SP - short
Cont..
 Variant III : SMS - cone shaped depression
EAC - ant wall(thick)bulge
SP - relatively long
 Variant IV : SMS - absent
EAC - ant wall bulge/oval

SP - very long
 Korner’s Septum

 Petro squamous lamina

Embryological fusion: squ/pet of T B
Divides mast pro sup(squ)/deep(pet)
 Consider if :
Difficult to approach

Small & constricted antrum

Anomalous
 Air cells
 Peri antral cells
 Tegmental cells
 Sinodural cells
 Perisinusal cells
 Central mastoid cells
 Mastoid tip cells
 Perifacial cells
 Zygomatic cells
CORTICAL MASTOIDECTOMY
SUMMARY
 Temporal bone is unique
Vol – 1 Cubic inch / Olive
Concentration of vital structures
Surrounded by pneumatic cells
 Modern era of microear surgery
Essential to understand the complex
anatomy of TB in all 3 dimentions.
Cont…
 CT / MR / MRA – imaging modalities
Proper imaging study
Plan appropriate treatment

 Otomicro surgery
Taken tremendous strides with the pioneering work of
Zollner & Wullstein.
Clear & magnified view with microscope / endoscope
Precise removal of disease with drill enhancing
surgeons skill to eradicate disease & restore hearing