Identify Malleusincus Head

To minimize potential labyrinthine or facial nerve injury, the initial drilling should be focused superiorly and anteriorly. The middle cranial fossa dura is identified and followed medially into the epitympanic space, where the fused heads of the ossicles are noted. Identifying the middle ear in this manner will help protect the facial nerve, which always lies medial to the ossicular mass in the epitympanum. It will also prevent drilling into the lateral semicircular canal, and avoid mistaking it for part of the atretic bone.

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