Colour Atlas of the Anatomy and Pathology of the Epitympanum by T. Palva

By T. Palva

This atlas supplies a close documentation of the very best booths of the center ear. New microdissection techniques were constructed, most significantly anterior microdissection. as well as the tympanic hollow space, this strategy permits an immediate view into the anterior membrane of Prussak's house, the anterior floor of the tensor fold, and the supratubal recess, components no longer explored prior. The normal and hitherto unknown auxiliary aeration and drainage pathways are proven intimately. Aeration of Prussak's area is documented utilizing either microdissection and serial sections; those pathways from the mesotympanum or from the reduce lateral attic are self sufficient of the tympanic isthmus. The pathology as a result of continual irritation at the aeration and drainage routes is additionally documented, and new surgical microdissection tools for elimination of the tensor fold are defined.

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Without surgical interference such cases lead to a prestage of an adhesive otitis media, with recurrent bouts of infection and with a continuing increase of the granulation tissue. The blocking tissue in the tympanic isthmus may present itself in less inflamed cases as web-type layers of connective tissue and in cases of longer duration as immature or mature connective scar tissue (fig. 51) or as a continuous mass of granulation tissue for the entire depth of the isthmus. In an ongoing chronic inflammation the granulation tissue appears already between the incus and the attic roof (fig.

36. Series G, adult case 55, right ear, superoposterior view. The thin lateral incudomalleal fold (horizontal arrow) runs anteriorly in a steadily descending slope along the inferior border of the incus (I) short process and body towards the lateral malleal space (oblique arrow). The head of the malleus (M) is close to the attic roof and the superior malleal ligament is short (vertical arrow). T = Tensor tendon; TF = tensor fold. Fig. 37. Series A, adult case 14, left ear, superior view. The lateral incudomalleal fold (horizontal arrow) is thin and there is a curved tissue strand (oblique arrow) in its anterior portion.

The presence of secretion, either serous or mucinous together with its cellular content, and the appearance of the epitympanic mucosa make it possible to draw conclusions of the duration and activity of the process. When organization phenomena are ongoing, the maturity of the granulation tissue, epithelialization of its surface and the formation of pseudocysts are important markers of the severity and duration of the process. Chronic inflammation, even if mild, causes many changes some of which appear in figure 55.

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