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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4399_Библиотеки_им_академика_М_И_Перельмана
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Figure 9–2a
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Figure 9–2b
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Figure 9–3a
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Figure 9–3b
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Figure 9–4a
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Figure 9–4b
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Temporal Bone Histology and Radiology Atlas182
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in the IAC. The cupula is projecting out from the crista
ampullaris of the lateral canal. The hematopoietic bone
marrow is seen anterior to the IAC and cochlea. The CT
image shows the epitympanic ossicles, two semicircular
canals entering the vestibule, the IAC, the cochlea, and
a pneumatized petrous apex with marrow bone more
anteriorly toward the clivus.
FIGURE 9–5
The incus continues to extend toward the aditus ad antrum as the short process. The macula of the utricle lies
in its elliptical recess. In the IAC, the superior vestibular
nerve can be seen. Aditus ad antrum and epitympanum can be clearly seen.
FIGURE 9–6
Over the apex of the cochlea lies a large semicanal,
which houses the tensor tympani muscle. The basal
and middle turns of the cochlea are clearly seen. Anterior to the tensor tympani muscle is the canal of internal carotid artery. The anterior epitympanic recess
(also known as sinus epitympanum or supratubal recess) is located anterior to the head of the malleus. The
“bony septum” that is called “cog” may extend from
the tegmen tympani to the cochleariform process and
separate the anterior epitympanic recess from the posterior epitympanic recess. It is common for cholesteatoma to extend into this space. The otologic surgeon
must be alert to search for cholesteatoma in this space
when doing surgery.
of the meatus, and passes to the cribrose area of the
basal turn.
FIGURE 9–8
The short process of the incus lies horizontally along
the floor of the aditus ad antrum. The malleus has three
ligaments, the anterior, superior, and the lateral mallear ligaments. The anterior mallear ligament appears
in this section. The saccule, utricle, and the macula of
the utricle are in view now. The saccule lies anteroinferiorly and the utricle is located posterosuperiorly in
the vestibule. The anterior mallear ligament and the
anterior process of the malleus are evident.
FIGURE 9–9
Prussak’s space is formed laterally by the pars flaccida
of the tympanic membrane, anterosuperiorly by the
lateral mallear ligament, and inferiorly by the anterior
and posterior mallear folds and ligaments. In this section, the anterior ligament, which is the anteroinferior
border of Prussak’s space, is seen. Prussak’s space is
a site for acquired cholesteatoma formation. A retraction pocket may precede cholesteatoma formation in
that site. Medially, note the relationship of the bipennate tensor tympani muscle to the protympanum and
the cochlea, and the facial nerve just posterior to the
cochleariform process.
FIGURE 9–10
Anterolateral to the malleus is the chorda tympani
nerve. This nerve leaves the facial nerve from its vertical lie before the facial nerve enters the stylomastoid
foramen. The chorda tympani then traverses across
the middle ear cavity and passes between the malleus
and the long process of incus and is seen here leaving
the tympanum anteriorly. At this level, the facial nerve
has a thin plate or sometimes dehiscence. The vestibulocochlear nerve is seen in the internal acoustic meatus. The cochlear nerve appears at the inferior aspect
FIGURE 9–7
This section shows the midmodiolar view of the cochlea. All three turns of the cochlea are visible. The upper and lower scalae join apically at the helicotrema.
The spiral ligament is located just under the external
wall of the bony cochlea and is lined on its internal surface in part by stria vascularis. This ligament contains
different types of fibrocytes. The stria vascularis extends from the spiral prominence to Reissner’s membrane. Under higher magnification, three types of cells,
marginal, intermediate, and basal cells can be identified in the stria vascularis. Spiral ganglion cells are
seen in Rosenthal’s canal. These cells can be counted
under high magnification. The total cochlear neuronal
Figure 9–5
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Figure 9–6
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Figure 9–7
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