A manual of operative surgery . ngles to Reids line, each one and a half inches long ; the anteriorpasses through the meatus, the other one and a quarter inchesbehind that opening (Barker) (Fig. 211, c). The dura materis exposed, and will usually be found to be without pulsation,and to bulge into the trephine hole. This change in the membraneis a certain sign, not necessarily of pus, but of increased intra-cranial tension. The dura mater is incised with the scalpel, and is then openedwith the aid of fine scissors and delicate-toothed forceps. The chap, ii] MENINGITIS AND CEREBRAL ABSCESS 71 di
A manual of operative surgery . ngles to Reids line, each one and a half inches long ; the anteriorpasses through the meatus, the other one and a quarter inchesbehind that opening (Barker) (Fig. 211, c). The dura materis exposed, and will usually be found to be without pulsation,and to bulge into the trephine hole. This change in the membraneis a certain sign, not necessarily of pus, but of increased intra-cranial tension. The dura mater is incised with the scalpel, and is then openedwith the aid of fine scissors and delicate-toothed forceps. The chap, ii] MENINGITIS AND CEREBRAL ABSCESS 71 division should be so made as to render the subsequent closureof the rents with sutures possible. A crucial incision will probablybe the most convenient. If pus be present beneath the durait will now escape ; the cavity may be washed out, and a drainagetube inserted. If no pus be discovered, the aspirating needle isintroduced ; if no pus be withdrawn, the puncture may be re-peated. The movement must be a direct thrust, no lateral. FIG. 219.—SKETCH OF AN ADULT SKULL TO REPRESENT AN OPERATION FOR TREATINGTHE CHIEF INTRACRANIAL COMPLICATIONS OF CHRONIC OTITIS MEDIA (reduced to one-half of natural size). a, Line of skin incision ; b, Pin of trephine placed i^ in. behind, and \ in. above, the centreof the external auditory meatus ; c, Area of bone removed by bone forceps ; d. Outline ofthe lateral sinus. movement being permissible, and no attempt must be madeto pass the needle from one point to another without removingand re-introducing it. When pus is discovered a pair of slendersinus forceps should be inserted along the side of the needle andthe track along which the pus may escape thus enlarged. Along the passage thus made a drainage tube of indiarubberor of silver is introduced. Rubber answers well, as it allows ofbeing shortened as required. A double or two-way tube is very 72 OPERATIONS ON HEAD AND NECK [part hi convenient for syringing. The length of tube within the skullshou
Size: 1756px × 1422px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, booksub, booksubjectsurgicalproceduresoperative
