A more satisfactory way of opening the skull, and one that makes
slipping of the skull-cap after restoration practically impossible,
is the method used by the writer, and illustrated in Fig. 26. The
scalp-incision and the folding back of the flaps are carried out as
described above. The right half of the anterior flap of the scalp
is then taken in the left hand and used to control the position of
the head, the latter being turned to the left as far as possible. An
oblique saw-cut is then made on the right side in a line extending
from the posterior margin of the site of the posterior fontanel, over
the right parietal eminence toward the right mastoid prominence. The
sawing begins on the greatest convexity and is continued upward a
slight distance beyond the median line, and downward far enough to
cross the level of the connecting horizontal cut to be made later at
a level just above the aural canal. The left half of the posterior
scalp-flap is now taken into the left hand and used to steady the
head while it is turned over to the right as far as possible. A
similar oblique cut is then made on the left side, crossing the
one made on the right, in the median line, behind the site of the
posterior fontanel, and extending down across the left parietal
eminence in the direction of the left mastoid prominence. While the
head is still held by the left half of the posterior scalp-flap a
horizontal saw-cut is begun on the left side, just above the aural
canal, intersecting the oblique cut posteriorly and continued around
to the front at a level just above the supraorbital ridges. When the
frontal region is reached the head is steadied by holding the left
half of the anterior portion of the scalp-flap. When the horizontal
cut reaches the right temple the right half of the anterior flap
is taken in the hand, and the head turned to the left while the
cut is carried around the right temporal region to intersect the
right oblique cut. When the skull-cap is removed there is formed
an interlocking joint (Fig. 27) which under ordinary conditions
holds the restored skull-cap firmly without wiring and without the
formation of a ridge or crease on the brow, since the bone cannot
slip. It is best, however, in the event of the shipment of a cadaver
by rail to wire the bones to prevent any forcible dislodgement.
[Illustration: FIG. 27.—Skull-cap after removal, showing posterior
interlocking joint.]
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