Comprehensive and Clinical Anatomy of the Middle Ear

Preface
Preface
Preface
Preface
Preface
Contents
1: Temporal Bone
	1.1	 Embryology of the Temporal Bone
		1.1.1	 Cartilaginous Neurocranium
			1.1.1.1	 The Cartilaginous Otic Capsule
		1.1.2	 Membranous Neurocranium and the Squamous Bone
		1.1.3	 The Viscerocranium
			1.1.3.1	 The Styloid Process
			1.1.3.2	 The Tympanic Bone
	1.2	 Perinatal Changes of the Temporal Bone
	1.3	 Postnatal Changes of the Temporal Bone
	1.4	 Anatomy of the Temporal Bone
		1.4.1	 The Petrous Bone
		1.4.2	 The Squamous Bone
		1.4.3	 The Tympanic Bone
		1.4.4	 The Styloid Bone
		1.4.5	 Temporal Bone Fissures
			1.4.5.1	 The Petrosquamous Fissure
			1.4.5.2	 Tympanomastoid Fissure
			1.4.5.3	 Tympanosquamous Fissure
			1.4.5.4	 The Petrotympanic Fissure
		1.4.6	 Temporal Bone Surfaces
			1.4.6.1	 The Lateral Surface (Fig. 1.12)
			1.4.6.2	 Posterior Surface
				1.4.6.2.1 Retrosigmoid Approach (Fig. 1.15)
			1.4.6.3	 Superior Surface (Fig. 1.16)
				1.4.6.3.1 Middle Cranial Fossa Approach
			1.4.6.4	 Inferior Surface (Fig. 1.22)
				1.4.6.4.1 Fish Infratemporal Fossa (ITF) Approach
	1.5	 Conclusion
	References
2: Middle Ear Cavity
	2.1	 The Lateral Wall
		2.1.1	 Embryology of the  Lateral Wall
		2.1.2	 Lateral Wall Anatomy
			2.1.2.1	 The Attic Outer Wall
			2.1.2.2	 The Tympanic Ring
				2.1.2.2.1 The Tympanic Sulcus
				2.1.2.2.2 Tympanic Spines
				2.1.2.2.3 Tympanic Canaliculi
			2.1.2.3	 The Tympanic Membrane
				2.1.2.3.1 The Tympanic Annulus
				2.1.2.3.2 Microscopic Structure of the Tympanic Membrane
					Pars Tensa
					Pars Flaccida
				2.1.2.3.3 Blood Supply of the Tympanic Membrane
				2.1.2.3.4 Nerves of the Tympanic Membrane
		2.1.3	 Mechanics of the Tympanic Membrane
			2.1.3.1	 Role in the Middle Ear Impedance Matching System
			2.1.3.2	 Role in the Middle Ear Amplifier System
	2.2	 The Inferior Wall (Jugular Wall)
		2.2.1	 Embryology of the Inferior Wall
		2.2.2	 Development of the Jugular Bulb After Birth
		2.2.3	 The Inferior Wall Anatomy
			2.2.3.1	 Jugular Bulb Anatomy
	2.3	 The Posterior Wall
		2.3.1	 Embryology of the Posterior Wall
		2.3.2	 Posterior Wall Anatomy
			2.3.2.1	 The Upper Part: The Aditus Ad Antrum
			2.3.2.2	 The Lower Part: The Posterior Wall of the Tympanum
				2.3.2.2.1 Posterior Wall Eminences
				2.3.2.2.2 Posterior Wall Ridges
	2.4	 The Superior Wall (The Tegmen)
		2.4.1	 Superior Wall Development
		2.4.2	 Superior Wall Anatomy
			2.4.2.1	 Supportive Mechanisms of the Tegmen
		2.4.3	 Surgical Anatomy of the Tegmen
			2.4.3.1	 Lateral-to-Medial Slope
			2.4.3.2	 Posterior-to-Anterior Slope
		2.4.4	 The Tegmen Dehiscence and Association to SSCC Dehiscence
	2.5	 The Anterior Wall (Carotid Wall)
		2.5.1	 Anterior Wall Development
			2.5.1.1	 Development of the  Carotid Canal
		2.5.2	 Anterior Wall Anatomy
			2.5.2.1	 The Lower Portion
			2.5.2.2	 The Middle Portion
			2.5.2.3	 The Upper Portion
			2.5.2.4	 The Carotid Artery and the Anterior Wall
				2.5.2.4.1 The Vertical Segment of the Petrous Carotid Canal
				2.5.2.4.2 The Horizontal Segment of the Petrous Carotid Canal
	2.6	 The Medial Wall (Cochlear Wall)
		2.6.1	 Embryology of the Medial Wall Structures
			2.6.1.1	 Facial Nerve: Tympanic Segment (See Chap. 6)
			2.6.1.2	 Oval Window
			2.6.1.3	 Fissula Ante Fenestram
			2.6.1.4	 Round Window
		2.6.2	 Medial Wall Anatomy
			2.6.2.1	 Tensor Tympani Muscle Bony Canal and the Cochleariform Process (Fig. 2.54)
			2.6.2.2	 Facial Nerve Canal
			2.6.2.3	 Lateral Semicircular Canal
			2.6.2.4	 The Cochlear Promontory
			2.6.2.5	 The Oval Window Niche
				2.6.2.5.1 Fissula Ante Fenestram
				2.6.2.5.2 Fissula Postfenestram
			2.6.2.6	 The Round Window
				2.6.2.6.1 The Round Window Niche
				2.6.2.6.2 Ridges of the RW Niche (Fig. 2.63)
				2.6.2.6.3 Spaces of the RW Niche
				2.6.2.6.4 The Round Window Chamber
				2.6.2.6.5 The Round Window Skeleton (Fig. 2.66)
				2.6.2.6.6 Topographic Anatomy of the Round Window
				2.6.2.6.7 The Round Window Membrane (Fig. 2.68)
			2.6.2.7	 Cochlear Aqueduct
			2.6.2.8	 Singular Nerve
	References
3: Middle Ear Contents
	3.1	 The Auditory Ossicles
		3.1.1	 Embryology of the Auditory Ossicles
			3.1.1.1	 Developmental Genetics of the Middle Ear and Its Contents
			3.1.1.2	 Stapes Development
				3.1.1.2.1 Footplate Development
					Classical Theory of Footplate Origin
					Alternative Theory of Footplate Origin
				3.1.1.2.2 Annular Ligament
				3.1.1.2.3 Stapes Ossification
			3.1.1.3	 Incus Development
			3.1.1.4	 Malleus Development
			3.1.1.5	 Congenital Ossicular Malformations
		3.1.2	 Anatomy of the Auditory Ossicles
			3.1.2.1	 The Malleus
				3.1.2.1.1 The Malleus Head
				3.1.2.1.2 The Neck
				3.1.2.1.3 The Manubrium (The Handle)
				3.1.2.1.4 Malleus Processes
				3.1.2.1.5 Malleus Ligaments (Figs. 3.23 and 3.24)
			3.1.2.2	 The Incus (Fig. 3.26)
				3.1.2.2.1 Body of the Incus
				3.1.2.2.2 Short Process of the Incus
				3.1.2.2.3 Long Process of the Incus
				3.1.2.2.4 Lenticular Process
				3.1.2.2.5 Ligaments of the Incus (Fig. 3.28)
			3.1.2.3	 The Stapes
				3.1.2.3.1 The Head
				3.1.2.3.2 The Crura
				3.1.2.3.3 The Footplate
				3.1.2.3.4 The Annular Ligament
	3.2	 Ossicular Articulations
		3.2.1	 Embryology of Ossicular Articulations
			3.2.1.1	 The Incudostapedial Joint
			3.2.1.2	 The Incudomalleal Joint
		3.2.2	 Anatomy of the Ossicular Articulations
			3.2.2.1	 The Incudomalleal Articulation
				3.2.2.1.1 Mechanics of the Malleus-Incus Complex (MIC)
			3.2.2.2	 The Incudostapedial Articulation (Figs. 3.31 and 3.32)
				3.2.2.2.1 Mechanics of the Incudostapedial Joint (ISJ)
			3.2.2.3	 The Stapediovestibular Joint (SVJ)
				3.2.2.3.1 Mechanics of the Stapes and Stapediovestibular Joint
				3.2.2.3.2 Ossicular Coupling (Fig. 3.36)
	3.3	 Middle Ear Muscles
		3.3.1	 Embryology of Middle Ear Muscles
			3.3.1.1	 Tensor Tympani Muscle
			3.3.1.2	 Stapedial Muscle
		3.3.2	 Anatomy of the Middle Ear Muscles
			3.3.2.1	 The Tensor Tympani Muscle (TTM)
			3.3.2.2	 Stapedial Muscle
	3.4	 Middle Ear Nerves
		3.4.1	 Facial Nerve Branches
		3.4.2	 Tympanic Plexus (Fig. 3.41)
	3.5	 Middle Ear Vessels
		3.5.1	 Embryology of Middle Ear Vessels (Fig. 3.47)
		3.5.2	 Anatomy of the Middle Ear Vessels (Fig. 3.54)
			3.5.2.1	 The Anterior Tympanic Artery
			3.5.2.2	 The Posterior Auricular Artery
			3.5.2.3	 Branches of the Middle Meningeal Artery
				3.5.2.3.1 The Superior Petrosal Artery
				3.5.2.3.2 The Superior Tympanic Artery
			3.5.2.4	 The Caroticotympanic Arteries
			3.5.2.5	 The Inferior Tympanic Artery
	3.6	 Middle Ear Mucosal Folds
		3.6.1	 Mucosal Fold Development
		3.6.2	 Mucosal Fold Anatomy
			3.6.2.1	 The Posterior Tympano-Malleal Fold
			3.6.2.2	 The Anterior Tympano-Malleal Fold
			3.6.2.3	 The Anterior Malleal Ligament Fold (AMF)
			3.6.2.4	 The Lateral Malleal Ligament Fold (LMF)
			3.6.2.5	 The Superior Malleal Fold (SMF)
			3.6.2.6	 The Lateral Incudomalleal Fold (LIMF)
			3.6.2.7	 The Medial Incudal Fold (MIF)
			3.6.2.8	 The Superior Incudal Fold (SIF)
			3.6.2.9	 Posterior Incudal Fold (PIF)
			3.6.2.10	 The Tensor Tympani Fold (TTF)
		3.6.3	 The Tympanic Diaphragm
		3.6.4	 The Tympanic Isthmus
			3.6.4.1	 The Anterior Tympanic Isthmus
			3.6.4.2	 The Posterior Tympanic Isthmus
	References
4: Middle Ear Compartments
	4.1	 Embryology of Middle Ear Compartments
		4.1.1	 The Saccus Anticus
		4.1.2	 The Saccus Medius
		4.1.3	 The Saccus Superior
		4.1.4	 The Saccus Posticus
	4.2	 The Protympanum
		4.2.1	 Development of the Protympanum
		4.2.2	 Anatomy of the Protympanum
			4.2.2.1	 Walls of the Protympanum
			4.2.2.2	 The Supratubal Recess (STR)
	4.3	 The Hypotympanum
		4.3.1	 Walls of the Hypotympanum
		4.3.2	 Air Cells in the Hypotympanum
			4.3.2.1	 Hypotympanic Air Cells
			4.3.2.2	 Retrofacial Cells
	4.4	 The Retrotympanum
		4.4.1	 Lateral Spaces
			4.4.1.1	 Facial Sinus
			4.4.1.2	 Lateral Tympanic Sinus
		4.4.2	 Medial Spaces
			4.4.2.1	 The Superior Retrotympanum
				4.4.2.1.1 Posterior Tympanic Sinus
				4.4.2.1.2 The Sinus Tympani
			4.4.2.2	 The Inferior Retrotympanum
				4.4.2.2.1 The Sinus Sub-tympanicus
				4.4.2.2.2 The “Subcochlear Canaliculus” Confound with the “Proctor’s Area Concamerata”
	4.5	 The Epitympanum or the Attic
		4.5.1	 The Upper Unit of the Attic
			4.5.1.1	 Posterior Attic or Posterior Epitympanum
				4.5.1.1.1 The Medial Posterior Attic
				4.5.1.1.2 The Lateral Posterior Attic
					The Upper Lateral Attic
					The Lower Lateral Attic or the Inferior Incudal Space (IIS)
			4.5.1.2	 Anterior Attic or Anterior Epitympanum
		4.5.2	 The Lower Unit of the Attic (Prussak’s Space) (Figs. 4.21, 4.22, and 4.32)
	4.6	 The Mesotympanum
		4.6.1	 Tympanic Membrane Compartments or Pouches (Fig. 4.38)
	4.7	 Middle Ear Ventilation Pathways
	4.8	 “Anatomo-physiological Addendum”: Middle Ear Aeration Pressure Regulation
		4.8.1	 The Middle Ear Mucosa
			4.8.1.1	 The Middle Ear Cleft: A “Miniature Nose and Lung System”
		4.8.2	 Combined Mucosal Cell and ET Pressure Regulation
		4.8.3	 Neural Control of Middle Ear Pressure Regulation
			4.8.3.1	 Peripheral Neural Receptors
			4.8.3.2	 Central Regulatory Mechanism for Middle Ear Aeration
	References
5: The Mastoid
	5.1	 Embryology of the Antrum and Mastoid
	5.2	 Postnatal Mastoid Pneumatization
	5.3	 The Tracts of Pneumatization
	5.4	 Mastoid Process Anatomy
		5.4.1	 Surface Landmarks of the Mastoid Process
			5.4.1.1	 The Temporal Line
			5.4.1.2	 Henle’s Spine
			5.4.1.3	 Mac-Ewen’s Triangle
		5.4.2	 Surgical Anatomy of the Mastoid Antrum
			5.4.2.1	 Position of the Antrum in Relation to Surface Landmarks
			5.4.2.2	 Deep Relationships of the Antrum
				5.4.2.2.1 The Lateral Semicircular Canal and the Solid Triangle
				5.4.2.2.2 The Petromastoid Canal
				5.4.2.2.3 The Mastoid Segment of the Facial Nerve
				5.4.2.2.4 The Sigmoid Sinus
				5.4.2.2.5 The Posterior Fossa Dural Plate
				5.4.2.2.6 The Tegmen Antri
				5.4.2.2.7 Trautman’s Triangle
				5.4.2.2.8 The Sinodural Angle (The Citelli Angle)
				5.4.2.2.9 Koerner’s Septum
		5.4.3	 The Aditus Ad Antrum
		5.4.4	 The Mastoid Air Cells
			5.4.4.1	 Squamo-mastoid Cells
			5.4.4.2	 Petrous Cells
				5.4.4.2.1 Perilabyrinthine Cells
				5.4.4.2.2 Apical Cells
				5.4.4.2.3 Accessory Air Cells
	5.5	 CT Evaluation
	5.6	 Addendum: Role of the Mastoid Air Cell System Volume
		5.6.1	 Gas Exchange
		5.6.2	 Buffer System
		5.6.3	 Middle Ear Mechanics
		5.6.4	 As Protector
	References
6: Facial Nerve
	6.1	 Facial Nerve Development
		6.1.1	 Facial Nerve Connections
	6.2	 Facial Nerve Anatomy
		6.2.1	 The Cerebellopontine Angle (CPA) Segment
		6.2.2	 The Internal Auditory Canal Segment (IAC)
		6.2.3	 The Facial Canal (Fallopian Canal)
			6.2.3.1	 The Labyrinthine Segment (First Segment)
			6.2.3.2	 The Geniculate Ganglion
			6.2.3.3	 The Greater Superficial Petrosal Nerve
			6.2.3.4	 The Tympanic Segment (Second Segment)
			6.2.3.5	 Second Genu
			6.2.3.6	 The Mastoid Segment (Third Segment)
				6.2.3.6.1 Relationship Between the Mastoid Segment of the Facial Nerve and the Tympanum
				6.2.3.6.2 Relationship Between the Mastoid Segment of the Facial Nerve and the Mastoid Structures
				6.2.3.6.3 The Nerve of Stapedial Muscle
				6.2.3.6.4 The Chorda Tympani Nerve
		6.2.4	 Vascularization of the Facial Nerve (Fig. 6.32)
			6.2.4.1	 Superficial Petrosal Artery
			6.2.4.2	 Stylomastoid Artery
	References
7: The Eustachian Tube
	7.1	 The Eustachian Tube Development
	7.2	 Postnatal Growth (Fig. 7.5)
	7.3	 Eustachian Tube Anatomy
		7.3.1	 The Bony Portion of the Eustachian Tube
		7.3.2	 The Junctional Segment or Isthmus
		7.3.3	 The Fibrocartilaginous Tube
			7.3.3.1	 The Cartilaginous Part (Fig. 7.14)
			7.3.3.2	 The Fibrous Part
			7.3.3.3	 Ostmann Fat Pad
			7.3.3.4	 The Pharyngeal End
	7.4	 Topographic Anatomy of the ET and ICA
	7.5	 Muscles of the Eustachian Tube
		7.5.1	 The Tensor Veli Palatini (TVP) Muscle
			7.5.1.1	 The Lateral Bundle
			7.5.1.2	 The Medial Bundle
		7.5.2	 The Levator Veli Palatini (LVP) Muscle (Fig. 7.22)
		7.5.3	 The Salpingopharyngeal Muscle
		7.5.4	 The Tensor Tympani Muscle
	7.6	 Eustachian Tube Blood Vessels
	7.7	 Eustachian Tube Nerves
	7.8	 Addendum: Physiology of Eustachian Tube Lumen and Mucosa
		7.8.1	 Eustachian Tube Lumen
		7.8.2	 Eustachian Tube Mucosa
		7.8.3	 Eustachian Tube Dynamics
		7.8.4	 Functions of the ET
		7.8.5	 Neural Control of Eustachian Tube Function
	7.9	 Conclusion
	References
8: Human Middle Ear and Phylogenetic Impacts
	8.1	 Comparative Anatomy and Phylogenetic Evolution of the Middle Ear Ossicles
	8.2	 Middle Ear Functions Through Phylogenesis
		8.2.1	 Middle Ear Mechanics
			8.2.1.1	 The Benefit of the Triple Ossicles System
			8.2.1.2	 Air as Isolator and Vehicle
		8.2.2	 Gas Exchange
	8.3	 Middle Ear Immunity
		8.3.1	 Middle Ear Innate Immunity
			8.3.1.1	 Physical and chemical barriers
			8.3.1.2	 Antimicrobial components
			8.3.1.3	 Cellular components
		8.3.2	 Adaptive Immunity and Immune Memory
		8.3.3	 Middle Ear Mucosal Response to Microorganisms
		8.3.4	 Middle Ear Immune Tolerance
	8.4	 Addendum
	8.5	 Conclusion
	References
Index