Operative surgery, for students and practitioners . he head. The incision- commences behind the ear, at thebase of the mastoid process, and folloAvs the line of origin of thetemporal muscle and terminates anteriorly just above the anteriorpart of the zygomatic arch. The flap thus marked out, and consist-ing of the skin and subcutaneous tissue, is dissected downward awayfrom the fascia covering the temporal muscle. A vertical incisionis made in the temporal fascia and the bone then exposed by penetrat-ing bluntly between the fibers of the temporal muscle down to thebone. The edges of the muscle
Operative surgery, for students and practitioners . he head. The incision- commences behind the ear, at thebase of the mastoid process, and folloAvs the line of origin of thetemporal muscle and terminates anteriorly just above the anteriorpart of the zygomatic arch. The flap thus marked out, and consist-ing of the skin and subcutaneous tissue, is dissected downward awayfrom the fascia covering the temporal muscle. A vertical incisionis made in the temporal fascia and the bone then exposed by penetrat-ing bluntly between the fibers of the temporal muscle down to thebone. The edges of the muscle are retracted with sharp periosteum covering the bone is incised and detached with the OPERATIONS UPON THE HEAD. 81 elevator aild cut away. An opening is made in the bone which hasbeen thus denuded. The bone is very thin. The opening may bemade with the Hudson or Doyen burr, etc., or it can be made withthe chisel and mallet. Through the small opening thus made inthe skull the bone is gouged away with a rongeur, etc., until an open-. Fig. 53.—Decompressive Operation in Temporal Region (Cushinf/). Thetemporal muscle has been split and the fibers drawn apart to expose the large piece of bone has been gouged out and the dura cut away. ing sufficiently large has been made. Usually a circular opening witha diameter of 6 to 8 cm. is made. Care is exercised not to injurethe middle meningeal artery when biting the bone away with therongeur. This opening uncovers the temporo-sphenoidal lobe andthe lowest part of the motor area. Hemorrhage from the bone is 6 82 HEAD AND FACE. controlled by means described on page 88. The dura is opened bya crucial incision. Arterial branches in the dura are secured beforeincising the dura by passing sutures around the vessels in a small,curved needle. Care must be exercised not to injure any of the ves-sels of the pia-arachnoid when incising the dura. The dura is pickedup with small tenaculum forceps and nicked with the knife. Thr
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