Pars flaccida retraction pocket

Introduction: Pars flaccida retractions have a vital role to play in the pathophysiology of cholesteatoma. Tos et al classified pars flaccida

retraction in to four stages.

Stage I: Pars flaccida is dimpled and is more retracted than normal. It is not adherent to the malleus.

Stage II: In this stage the retraction pocket is adherent to the handle of malleus. The full extent of the retraction pocket can be clearly seen.

Stage III: In this stage part of the retraction pocket may be hidden. There may also be associated erosion of the outer attic wall (scutum).

Stage IV: In this stage there is definite erosion of the outer attic wall. The extent of the retraction pocket cannot be clearly seen as most of it are hidden from the view.

This classification described by Toss is fairly simple to apply, the only difficulty being the difficulty in making a distinction between stages 3 and 4. Hence for practical purposes these two stages are grouped together.

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  Image showing Toss type I retraction pocket

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  Image showing Toss type II retraction pocket

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  Image showing Toss type III retraction pocket

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  Image showing Toss type IV retraction pocket