The anterior atticotomy is used when cholesteatoma originates from an attic retraction pocket, which is not thought to extend beyond the aditus into the mastoid antrum, or if the extent of disease is unknown. It is also useful in the management of cholesteatoma associated with tympanic membrane perforations, or involving the ossicular chain, and congenital cholesteatoma originating in the middle ear. other indications include the management of congenital conductive hearing loss with middle ear reconstruction, ossicular chain problems, and facial nerve injuries in the middle ear and mastoid
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