Endoscopic Anatomy of the Retrotympanum

KEY POINTS

  •  The retrotympanum is located at the posterior portion and houses several important and complex anatomic and surgical structures.
  •  The greater the depth of the subpyramidal space (SS), the more is a surgical approach at high risk of leaving residual cholesteatoma.
  •  Use of the endoscope in the middle ear recesses in cholesteatoma surgery may reduce the residual cholesteatoma rate. Using a transcanal minimally invasive approach allows the preservation of bone and mucosa of the mastoid cell system. This atraumatic approach is a suitable method for exploring the mesotympanic structures.
  •  In type C sinus tympani (ST), especially associated with a well-developed mastoid cell system, it is not always possible to have a good control of the ST using endoscopes; in these cases, a combined (endoscopic-microscopic) posterior retrofacial approach is suggested.