. Diseases of the ear : a text-book for practitioners and students of medicine. eanterior flap causes it to be-come oedematous almost im-mediately, thus increasing thedifficulty with which it is drawnforward, rendering a perfectexposure of the parts impossi-ble. If the line of incision ismade so close to the auricularinsertion as to admit of the in-troduction of a line of suturesonly, the field of operation willbe much better exposed, whilesubsequent deformity will beprevented, the cicatrix beingconcealed completely by the Fig. 146.—Hartauricle, which resumes an abso-lutely normal position. Th
. Diseases of the ear : a text-book for practitioners and students of medicine. eanterior flap causes it to be-come oedematous almost im-mediately, thus increasing thedifficulty with which it is drawnforward, rendering a perfectexposure of the parts impossi-ble. If the line of incision ismade so close to the auricularinsertion as to admit of the in-troduction of a line of suturesonly, the field of operation willbe much better exposed, whilesubsequent deformity will beprevented, the cicatrix beingconcealed completely by the Fig. 146.—Hartauricle, which resumes an abso-lutely normal position. Thesoft parts should be divided to the bone throughout theentire extent of the incision. If bleeding is free, the largervessels may be grasped with clamps, although it is better or-dinarily to delay this until the periosteum has been constitutes the next step of the operation: The entireanterior flap is pushed forward by means of an elevator car-ried beneath the periosteum,, raising this and the overl3ingmuscular structures from the bone, the parts being pushed. mann s perios-teum elevators. Fig. 147.—Rongeurfoiceps. Fig. 148.—Sharp spoon. forward until the posterior and superior margins of the bonycanal are plainly in view. The posterior flap is elevated in asimilar manner. All bleeding points are now caught by meansof clamps. The auricle is held forward by a narrow retractorinserted into the meatus, the instrument being intrusted to thehands of the assistant. The upper part of the incision is filledwith sponges, in order that all oozing may be controlled, whilethe operator directs his attention to clearing the aponeurosisof the sterno-mastoid muscle from the tip of the process. 5i8 THE MASTOID OPERATION. This is best done with blunt scissors curved on the flat,which can be closely applied to the bony surface and madeto divide the dense fibrous tissue by successive short must be taken to hug the bone closely, otherwise thelarge vessels of the neck m
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