EXERCISE 4

PHOTO ATLAS OF ENDOSCOPIC ENDOMEATAL CADAVERIC DISSECTION OF TEMPORAL BONE

ENDOSCOPIC SUPERIOR TYMPANOTOMY

STEP A – Visualisation of epitymanic diaphragm. once the TM is removed from ossicles the epitypanic diaphragm is visualised with 0 degree endoscope
Epitympanic diaphragm seperates upper lateral attic to lower lateral attic (prussaks space)

STEP B – Removal of epitympanic diaphragm with a pick the diaphragm including LML and LIML is ruptured and removes The upper lateral attic including lateral malleolar space is visualised with 0 degree endoscope

STEP C – VIsualisation of lateral attic space.
The lateral attic space including neck, short process of malleus and long process of incus are visualised

STEP D – Removal of squamosal cap. genle removal of squamosal cap (posterior scutum) with curette or with pizzo exposes auditus and posterior attic space Incudo malleal joint is seen clearly The bony bridge between facial recess and auditus is preserved This bridge corresponds to incus bridge on mastoid side In superior tympanotomy the upper attic is not exposed

These are specefic exercises in endoscopic endomeatal temporal cadaveric dissection

Labelling:
1 – Tympanic diaghpragm
2 – scutum
I – Incus
LML – posterior edge of lateral malleal ligament
SC – squamosal cap of auditus
LAS.. Lateral attic space
BR – Bony ridge seperates auditus and facial recess.