The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
(_b_) _The malar tubercle._ A slight prominence on the posterior border
of the frontal process of the malar bone, about ¹⁄₄ inch below the
external angular frontal process.
(_c_) _The temporal crest._ A prominent ridge that is directed upwards
and backwards from the external angular frontal process. The crest cuts
across the lower portion of the parietal bone, passing below the
parietal prominence, and curves downwards towards the upper and
posterior portion of the mastoid process. It terminates by becoming
continuous with the upper root of the zygomatic process. The crest
consists of two parts, the upper and lower temporal crests. To the upper
is attached the temporal fascia, to the lower the temporal muscle. The
lower crest is almost invariably the more prominent.
(_d_) _The parietal prominence._ The central and most prominent part of
the parietal bone. It indicates the point at which ossification
commenced, and lies about ³⁄₄ inch above the termination of the
posterior horizontal limb of the fissure of Sylvius.
(_e_) _The zygoma._ When traced in the backward direction, the zygoma is
found to divide immediately in front of the ear into three roots, of
which the anterior, merging into the eminentia articularis, and the
middle, aiding in the formation of the post-glenoid process, are of no
practical utility in surface-marking. The upper or posterior root sweeps
backwards above the external auditory meatus to become continuous with
the suprameatal and supramastoid crests, the former of which forms the
upper boundary of _Macewen’s suprameatal triangle_, a triangular
depression at the upper and posterior border of the external auditory
meatus. This triangle may be taken as representing the opening of the
mastoid antrum into the middle ear.
These landmarks having been determined, the following structures may be
mapped out on the surface of the skull.
=The middle meningeal artery.= This artery is given off from the
internal maxillary; after a short extra-cranial course it enters the
skull through the foramen spinosum, and soon divides into two main
terminal branches. The site of division corresponds to a point situated
just above the centre of the zygoma.
The _anterior branch_ passes at first in a forward and upward direction
towards the anterior inferior angle of the parietal bone, and then turns
upwards and backwards towards the vertex of the skull. The main ‘danger
zone’ in the course of this vessel may be mapped out by taking points
which lie respectively 1, 1¹⁄₂, and 2 inches behind the external angular
frontal process and an equal distance above the upper border of the
zygoma. A line uniting these three points represents that part of the
anterior division of the middle meningeal artery which is most liable to
injury and which therefore most frequently requires exposure.
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