Implications of Middle Cranial Fossa Dural Plate, It’s Importance in Sclerotic Mastoid to Identify Mastoid Antrum and to Avoid Complications

Abstract Aim: To correlate middle cranial fossa dura with mastoid antrum in sclerotic mastoids with absent/rudimentary spine of Henle. Materials and Methods: The prospective study was conducted in 38 patients with chronic otitis media having rudimentary or absent spine of Henle in the Department of Otolaryngology and Head and Neck at R. L. Jalappa Hospital and Research Center from December 2021 to December 2023. Results: In our study, majority were males with involvement of the right ear more than left. Most of the patients had symptoms of chronic ear discharge with moderate conductive hearing loss. Some patients had associated ear pain, tinnitus and vertigo. Four patients had large central perforation. Twenty-eight cases had sclerotic mastoid and diploic in 10 patients in high-resolution computed tomography of temporal bone. Nine patients had high jugular bulb, 30 had low lying dura, and 15 with anteriorly placed sigmoid sinus. All cases underwent cortical mastoidectomy with tympanoplasty and epitympanotomy in seven cases. Intraoperatively, 9 cases had absent spine of Henle and 29 had rudimentary spine of Henle. Conclusion: In sclerotic mastoids with absent or rudimentary spine of Henle to address the antrum is challenging when there is anteriorly placed sigmoid sinus and low-lying or undulating dura. The definite reference to approach mastoid antrum is to follow the pinkish hue of the dural plate with least complications.