Complete exposure of the attic and aditus, having removed the entire lateral wall of these cavities, through the enlarged external auditory canal.

An atticoaditotomy is mainly used in the surgery for chronic otitis media with cholesteatoma.

The atticotomy has been completed and the temporal bone is ready for the atticoaditotomy procedure. The critical structures are indicated in the figure.

FP: Facial prominence

FR: Facial recess

IB: Incus body

MH: Malleus head

ZR: Zygomatic root

The lateral wall of the aditus is drilled using a small cutting burr. Care should be taken not to let the burr touch the medial wall of the aditus. During the operation, if the view is restricted by the cholesteatoma, the posterior ligament of the incus is a good indicator in identifying the location of the horizontal semicircular canal.

II: 2–3mm cutting burr

MIL: Posterior ligament of incus

AD: Aditus

PLI: Posterior ligament of incus