The lateral malleal ligament is a fold of mucosa and fibrous tissue connecting the neck of the malleus to the posterior tympanic notch (notch of Rivinus), forming the lateral boundary of the Prussak space.
Defines the lateral wall of Prussak space (the superior recess of the tympanic membrane), which is the primary site of pars flaccida retraction and cholesteatoma formation. Acts as a lateral suspensory structure for the malleal neck.
The lateral malleal fold and Prussak space are the anatomical basis of pars flaccida cholesteatoma. The lateral malleal ligament is identified and released during surgical access to the epitympanum. Its integrity is assessed when planning the management of superior tympanic membrane retraction.
Retraction of the pars flaccida into Prussak space lateral to the malleal fold, the earliest stage of attic cholesteatoma formation requiring monitoring or surgical intervention.
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