The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
In such cases the fracture may extend on each side
up on to the vault in such a manner that the two
segments are merely united by the soft parts;
whether the fracture be so complete or not, a more
minute examination of the line of separation will
evidence many interesting points. An inspection of
the anterior aspect of the posterior fragment
shows that the fracture passes just in front of
the geniculate ganglion of the facial nerve, the
ganglion being laid bare, whilst its petrosal
branches are usually torn. The fracture also
passes anterior to the Eustachian tube and the
horizontal part of the internal carotid artery. On
examining this posterior fragment the following
structures will be seen, passing from without
inwards: the posterior half of the external
auditory meatus, the mastoid antrum, the lacerated
membrane and the ossicles of the middle ear, the
geniculate ganglion of the facial nerve, the
Eustachian tube, the horizontal part of the
internal carotid artery, the Gasserian ganglion,
and the posterior half of the sphenoidal sinus in
the middle line (see also Fig. 39).
After reaching the sphenoidal body, the
alternative course for the fracture to pursue is
to pass towards the opposite sphenoidal fissure
and, tearing off the anterior clinoid process, to
be directed across the anterior fossa, parallel to
the original direction but not in the same
straight line.
[Illustration: FIG. 34. DIAGRAM OF LINES PURSUED BY BASIC FRACTURES.
Force applied to the region of the external ear. _a_ ... _a_, The
‘typical’ basic fracture (see also Fig. 30).]
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