The Epitympanum Revisited: Endoscopic Anatomy

Abstract

In contrast to other means of studying the epitymapnum, the endoscope allows unparallel access without disruption of anatomy. The aim of this study is to delineate the anatomy of the epitympanum through transcanal endoscopy. Systematic dissection of anatomic specimens. We performed systematic endoscopic dissection of 20 ears in 10 fresh frozen anatomical specimens. A detailed flow sheet was filled up documenting the status of the lateral attic folds, the tensor fold, the cog and the tensor folds, the supratubal recess, and the patency of the anterior and posterior isthmus. None of the ears showed indication of previous chronic otitis media. The lateral incudomallear fold was intact in all but one ear. The lateral mallear fold was intact in all specimens. The tensor fold was complete in 16 ears and partial in four. Two of these ears belonged to the same specimen. The epitympanic diaphragm was complete in 15 out of 20 ears in 10 anatomic specimens. The endoscope allows for assessment of the attic anatomy and integrity of the diaphragm without undue disruption of anatomy. The epitympanic diaphragm is present in the majority of healthy ears and can in theory serve as the anatomic basis for the isolated attic retraction.Keywords Epitympanum 1 Á Endoscopic ear surgery 2 Á Lateral incudomallear fold 3 Á Lateral mallear fold 4 Á Tensor fold 5 Á Epitympanic diaphragm 6

Distribution of different morphological types of anterior epitympanic plate “cog” and Köerner’s septum in CT images of cholesteatomatous and non-cholesteatomatous CSOM: is it really significant?

“…The anterior epitympanic recess (AER) is frequently involved in chronic infections and represents a common location of the more common pars flaccida growth [8,25]. The complexity of the anatomical architecture of epi-tympanum necessitates accurate and deep knowledge of the surgeon about the spatial relationships present at this site, thus avoiding misguided procedure and inadvertent injury of vital structures [8,26,27].…”

“…The trans-canal endoscopic and microscopic ear surgery approaches offer a new era in the management of limited attic cholesteatoma, providing less invasive surgical technique [21][22][23]. Still, less invasive surgeries are questioning identification of some landmarks; the "Cog" and "KS," both serving as a guidance route to the attic in both approaches [24,25]. The aim of this study is to evaluate a statistical relation between the morphological types of the temporal bone anatomical structures, namely the "cog" and "KS" with an evaluation of their incidence in CSOM with or without cholesteatoma.…”

Endoscopic Anatomy of the Tensor Fold and Anterior Attic

“…More recent studies provided important insights on the anatomy as seen by endoscopy. [10][11][12] With the advancement of the angled endoscope and high-resolution camera, it has been possible to look around the corner and magnify small details of this complex anatomy. To summarize the results of these previous anatomical studies, we illustrate a table with the reported findings ( Table 2).…”

“…The earlier anatomical studies of the anterior epitympanum were mainly based on histological sections. More recent studies provided important insights on the anatomy as seen by endoscopy 10‐12 . With the advancement of the angled endoscope and high‐resolution camera, it has been possible to look around the corner and magnify small details of this complex anatomy.…”

Endoscopic ear surgery: then and now, review article

“…The structures in this space were described like the ponticulus and subiculum with their variations [27]. The attic also was revisited endoscopically with its two main parts the anterior and posterior epitympanic spaces with clarification of the attic diaphragm [28]. The protympanum was also described endoscopically with its two main conformations with description of the protinuculum separating it from the hypotympanum [29].…”