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Suspensory ligaments of the middle ear ossicles

Last revised by Daniel J Bell on 25 Aug 2022

The suspensory ligaments of the middle ear ossicles are ligaments within the middle ear which attach the ossicles to the walls of the mesotympanum 1. The ligaments help the ossicles transmit sound from the tympanic membrane to the oval window.

Gross anatomy

Origins and insertions of the suspensory ossicular ligaments 2:

  • anterior malleal ligament 
  • lateral malleal ligament
    • origin: neck of malleus
    • inserts: tympanic notch
  • superior malleal ligament
    • origin: head of malleus
    • inserts: roof of the middle ear cavity
  • posterior incudal ligament
Function

The ligaments work with the ossicular apparatus to aid normal conduction of sound across the middle ear 2. They limit the direction of motion of the ossicles and their supporting structures define their rotational axes. Their function has been shown to be most pronounced at low frequencies 3.

Radiographic features

CT

All four of the ligaments may be seen, to variable degrees in different subjects, as thin linear structures on high-resolution temporal bone CT 2.

These ligaments may sometimes be calcified or thickened, leading to ossicular fixation, most commonly due to chronic otitis media.

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