Objectives:
1- Describe the anatomy of the Prussak's space (Ps) utilizing the recently
available data due to the incorporation of endoscopes in its studying.
2- Evaluate the previously described theories about its development, physi-
ology, aeration and pathophysiology of its diseases.
Methods:
Fifty-five temporal bones were dissected, and the anatomical details were
studied utilizing an operating microscope and the otoendoscopes.
Results:
Being a 3D 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 was demonstrated by the development
of the mucosal folds, pouches and pathways. First type and the
most
common (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
unlikely to what has been usually thought, has different types. Although
the
differences between these types might look trivial, they mostly contribute
majorly 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.