The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
=The influence of sutures on the line of the fracture.= Complete
maceration of the skull is always essential in endeavouring to estimate
in what way the various sutures of the skull influence the extent and
direction of a fracture. Sutural separation is generally regarded as of
infrequent occurrence. An examination of a large number of macerated
skulls has shown, however, that sutural separation is in reality of
common occurrence. Certain sutures show a special liability to such
changes, especially the masto-occipital, the petro-occipital, and the
petro-sphenoidal. Separation of the sutures is more common in the young
adult; in the infant and in the old such conditions are seldom observed.
Allusion has already been made to the fact that forces transmitted from
the vault to the base, or vice versa, undergo a marked diminution in
intensity when the sutures of the skull are encountered, the ‘fracture’
showing a marked disposition to follow the line of the suture. When the
force is excessive, all rules are temporarily in abeyance, but, under
ordinary circumstances, the separation along the line of a suture
corresponds fairly accurately with the dentations and serrations of the
suture involved. Sutural separation without actual fracture is a
possible occurrence, but is decidedly rare. Such isolated fractures are
confined, more or less, to the sagittal suture in the vault, and the
masto- and petro-occipital sutures in the base.
=The influence of air-sinuses, &c., on the line of the fracture.= The
_sphenoidal sinuses_, two in number, are usually separated from one
another by a thin septum. This septum is, however, often deficient, and
a single cavity exists. The sinuses make their appearance about the
seventh or eighth year; they vary greatly in size but, when fully
developed, occupy the greater part of the so-called body of the
sphenoid, extending backwards almost as far as the junction of the
basi-sphenoid and basi-occiput, and spreading outwards into the wings of
the sphenoid and over the roof of the orbit.
The sinus is bounded on all sides by a thin lamella of bone; its roof
forms part of the middle fossa of the skull, the sides are separated by
a thin bony wall from the cavernous venous sinus, and the floor aids in
the formation of the roof of the naso-pharynx. There exists, therefore,
in the very centre of the base of the skull--in the region of the
so-called buttress of connexion between the posterior and anterior
segments of the skull--an exceedingly weak area, one which must be
implicated in the great majority of basic fractures. The ‘weak line’ of
the base of the skull--previously referred to--is now still more
accentuated.
Public-domain text, read in full here on John Shaqi.
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