Complete exposure of the attic and antrum, having removed the entire lateral wall of these cavities. The superior and posterior walls of the external auditory canal have to be drilled extensively during this procedure.

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

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

PLI: Posterior ligament of incus

SPI: Short process of incus

ZR: Zygomatic root

As with all inside-out techniques, first the lateral part of bone is drilled, which prevents working blindly more medially, and the created cavity is enlarged extensively toward the dura of the middle cranial fossa.

II: 3–4mm cutting burr

MIL: Middle cranial fossa dural plate