Prussak’s Space: Anatomy Revisited

Abstract

Objectives:

(1) Describe the anatomy of Prussak’s space (PS) using the recently available data due to the incorporation of endoscopes in its studying. (2) Evaluate previously described theories about its development, physiology, aeration, and pathophysiology of its diseases.

Methods:

Fifty-five temporal bones were dissected, and anatomic details were studied using an operating microscope and otoendoscopes.

Results:

PS is a 3-dimensional sagittal space located laterally and superficially to the tympanum and formed by mucosal and bony walls. Four types of PS could be distinct based on the pathways of their aeration and communication with the various spaces and areas of the tympanum, as demonstrated by the development of the mucosal folds, pouches and pathways. The first and most common type (71%) was aerated solely retrogradely via the posterior pouch of von Troeltsch. Second type (2%) was only aerated via the anterior pouch of von Troeltsch. Third type (2%) was only aerated through a special superior mucosal pathway. Spaces classified under the fourth PS type (25%) were aerated through combined or multiple pathways of the above types.

Conclusions:

PS, unlike what has been usually thought, has different types. Although the differences between these types might look trivial, they mostly contribute in the development and progress of the space pathological conditions. This might play a role in the explanation of the PS isolated infections and also the mechanism of retraction pockets and cholesteatoma formation and the modes of their extension.