Identify the incus

Re-orientate to the surgical position. Anterior to the lateral semi-circular canal is the short process of the incus. Always use a diamond burr in the vicinity of the structure and you could use a slightly smaller burr so that you can see around it.

Be aware that the incus can be immediately underneath this area, so run parallel to the external ear canal and just keep taking the very leading edge of bone away. In this situation the disadvantage of using a large burr is that you might not be able to see around it. You should see the incus. Remove the bone nearby in a very controlled manner, by using a slightly smaller burr and drilling along the edge of the bone. You could use a little more magnification at this stage before the dissection proceeds any further. You can also rotate the patient away. In doing so it becomes very clear that the incus is close by.