The superior ligament of the incus is a small fibrous band connecting the body of the incus to the tegmen in the epitympanum, providing additional superior suspension of the incus.
Assists in maintaining the incus body in its correct superior position, complementing the posterior incudal ligament. The combined ligamentous support positions the incus for optimal sound energy transfer.
Attic disease (pars flaccida cholesteatoma) preferentially destroys the superior incudal ligament as it enters the epitympanum. Loss of this ligament combined with erosion of the posterior ligament produces incus instability in the most common cholesteatoma pattern.
Epitympanic cholesteatoma eroding the superior incudal ligament and invading the epitympanic space, requiring canal wall up or down tympanomastoidectomy.
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