Prussak's space
| Prussak's space | |
|---|---|
membrana tympani with the hammer and the chorda tympani, viewed from within, from behind, and from above. | |
 Chain of ossicles and their ligaments, seen from the front in a vertical, transverse section of the tympanum. | |
| Anatomical terminology] |
In
neck of the malleus
. From the neck of the malleus, the anterior malleolar fold and the anterior ligament arise, demarcating Prussak's space anteriorly. Ventilation of Prussak's space is only possible posteriorly above the posterior malleus fold.
It communicates with the posterior pouch of von Troltsch.[1]
It is named after the
Boundaries
- Medially: neck of malleusand lateral malleolar ligament
- Laterally: pars flaccida
- Inferiorly: lateral process of malleus
- Superiorly: lateral malleolar fold and scutum
- "Anteriorly:" anterior malleolar ligament
Clinical significance
Prussak's space is important because it is a site for
pars flaccida acquired cholesteatoma formation.[5]
A cholesteatoma forms when there is a deep retraction pocket in the tympanic membrane. The lining of the tympanic membrane, which is skin, is shed, but if the membrane is retracted it gets trapped. The debris collects and enlarges and ultimately forms a cholesteatoma. This cholesteatoma, in turn, can erode the middle ear ossicles, facial nerve, inner ear and even involve the brain.
From Prussak's space, located in the epitympanum, cholesteatoma patterns of spread are:
- Posterior epitympanum - through superior incudal space to mastoid antrum,
- Posterior mesotympanum - inferiorly through the posterior pouch of von Troeltsch to the stapes, round window, sinus tympani and facial recess.
- Anterior epitympanum - anterior to head of malleus, may gain access to supratubal recess via anterior pouch of von Troeltsch.