A patient with attic cholesteatoma undergoes canal wall up mastoidectomy. Residual disease is most likely to be missed in a recess that lies medial to the facial nerve and pyramidal eminence, deep to the facial recess. This recess is the:

• A Supratubal recess
• B Facial recess
• C Sinus tympani ✓
• D Anterior epitympanic recess

Explanation

The sinus tympani is a deep bony recess on the posterior mesotympanum lying medial to the pyramidal eminence and facial nerve, bounded by the ponticulus below and the subiculum above. Because it is hidden behind the facial nerve, it is inaccessible to direct surgical vision, making it the classic site of residual cholesteatoma. The facial recess lies lateral to the facial nerve and is surgically accessible.

Reference: Scott-Brown's Essential Otorhinolaryngology, 3rd ed.

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Written and medically reviewed by the StethoPrep medical team.