The superior ligament of the malleus connects the head of the malleus to the roof of the epitympanum (tegmen tympani), providing the primary vertical suspension of the malleus.
Suspends the malleus from the tegmen, maintaining the vertical position of the handle in contact with the tympanic membrane. Acts as the primary superoinferior stabiliser of the ossicular chain.
Superior malleal ligament laxity or disruption allows inferior migration of the malleus, stretching the tympanic membrane and altering its vibratory mechanics. Assessment of this ligament is part of complete ossiculoplasty planning.
Vertical malleal instability from superior ligament laxity producing altered sound transmission mechanics and high-frequency conductive hearing loss.
Epitympanic cholesteatoma eroding the superior malleal ligament as it expands in the attic, requiring surgical clearance and reconstruction.
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