Atticotomy for cholesteatoma

When a cholesteatoma extends beyond the confines of the otoscopically visible middle ear, it is necessary to remove cranial bone to reach the temporal bone spaces above and behind the accessible middle ear. In the above figure, the scutum (the triangular plate of bone forming the lateral wall of the attic) has been drilled away to expose the cholesteatoma surrounding the malleus head and incus body.