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Anatomical variants of tympanic compartments and their aeration pathways involved in the pathogenesis of middle ear inflammatory disease.

Maniu A, Catana IV, Harabagiu O, Petri M, Cosgarea M - Clujul Med (2013)

Bottom Line: When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area.This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

ABSTRACT

Aim: The aim of this article is to review the anatomy of middle ear compartments and folds and to demonstrate through anatomical evidence their presence at birth. Additionally, their role in the obstructions of middle ear ventilatory pathway is highlighted.

Methods: Ninety-eight adult temporal bones, with no history of auricular disease and fifteen newborn temporal bones were studied by micro dissection. Documentation was done by color photography using the operation microscope.

Results: Our micro-dissections have showed that mucosal folds from the middle ear are steadily present since birth, given that they were found in all newborn temporal bones. The mucosal folds in our normal adult material, showed some variations including membrane defects but they were constantly present. Our micro dissections showed that the epitympanic diaphragm consisted, in addition to malleal ligamental folds and ossicles, of only two constantly present folds: the tensor tympani fold and the incudomalleal fold. When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.

Conclusions: The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area. This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

No MeSH data available.


Related in: MedlinePlus

Superior view of the tympanic cavity. 1. Incus. 2. Malleus. 3,4. Superior folds in the anterior part of the epitympanum.
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f9-cm-86-352: Superior view of the tympanic cavity. 1. Incus. 2. Malleus. 3,4. Superior folds in the anterior part of the epitympanum.

Mentions: The medial incudal fold connects the short and long processes of the incus with the stapes. In our dissectional study we did not constantly find it, but it was present in 11% of temporal bones. When this fold was present, its insertion was found to be at the medial wall of the attic Interossicular fold connects the long process of the incus with the handle of the malleus. In our dissection it was present in 13% of pieces. Stapedial folds are located between the incudostapedial articulation and the internal wall of mesotympanum and the obturator fold between the cruras of the stapes. These folds were found only in 18% and 9% of temporal bones. Posterior incudal fold emerges from posterior incudal ligament and inserts onto the medial attic wall. In our temporal bone series this fold was present in 15% of pieces. In 18% of pieces we found some very thin folds in the anterior part of the attic above tensor tympani fold (Fig. 8). Superior malleal fold that accompanies superior malleal ligament was present in 78% of pieces (Fig. 9).


Anatomical variants of tympanic compartments and their aeration pathways involved in the pathogenesis of middle ear inflammatory disease.

Maniu A, Catana IV, Harabagiu O, Petri M, Cosgarea M - Clujul Med (2013)

Superior view of the tympanic cavity. 1. Incus. 2. Malleus. 3,4. Superior folds in the anterior part of the epitympanum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4462447&req=5

f9-cm-86-352: Superior view of the tympanic cavity. 1. Incus. 2. Malleus. 3,4. Superior folds in the anterior part of the epitympanum.
Mentions: The medial incudal fold connects the short and long processes of the incus with the stapes. In our dissectional study we did not constantly find it, but it was present in 11% of temporal bones. When this fold was present, its insertion was found to be at the medial wall of the attic Interossicular fold connects the long process of the incus with the handle of the malleus. In our dissection it was present in 13% of pieces. Stapedial folds are located between the incudostapedial articulation and the internal wall of mesotympanum and the obturator fold between the cruras of the stapes. These folds were found only in 18% and 9% of temporal bones. Posterior incudal fold emerges from posterior incudal ligament and inserts onto the medial attic wall. In our temporal bone series this fold was present in 15% of pieces. In 18% of pieces we found some very thin folds in the anterior part of the attic above tensor tympani fold (Fig. 8). Superior malleal fold that accompanies superior malleal ligament was present in 78% of pieces (Fig. 9).

Bottom Line: When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area.This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

ABSTRACT

Aim: The aim of this article is to review the anatomy of middle ear compartments and folds and to demonstrate through anatomical evidence their presence at birth. Additionally, their role in the obstructions of middle ear ventilatory pathway is highlighted.

Methods: Ninety-eight adult temporal bones, with no history of auricular disease and fifteen newborn temporal bones were studied by micro dissection. Documentation was done by color photography using the operation microscope.

Results: Our micro-dissections have showed that mucosal folds from the middle ear are steadily present since birth, given that they were found in all newborn temporal bones. The mucosal folds in our normal adult material, showed some variations including membrane defects but they were constantly present. Our micro dissections showed that the epitympanic diaphragm consisted, in addition to malleal ligamental folds and ossicles, of only two constantly present folds: the tensor tympani fold and the incudomalleal fold. When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.

Conclusions: The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area. This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

No MeSH data available.


Related in: MedlinePlus