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John J. (John Joseph) McGrath.

Operative surgery, for students and practitioners online

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COLLEGE OF

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Operative Surgery



FOR STUDENTS AND PRACTITIONERS



JOHN J. McGRATH, M.D.

Clinical, Professor of Surgery, Fordham University; professor of Operative

Surgery, New York Post-Graduate Medical School; Consulting Surgeon

TO THE People's Hospital; Visiting Surgeon to the Harlem and

New York Foundling Hospitals; Fellow of the New

York Academy of Medicine; Member of the

American Medical Association.



FOURTH Revised and Enlarged Edition



mftb 364 Ulliisttations, UncluMna ffulUpacie Color
an& 1balt*=tone




PHILADELPHIA

F. A. DAVIS COMPANY, Publishers

1913



1 Dii



COPYRIGHT, 1902

COPYRIGHT, October, 1905

COPYRIGHT, October, 1909

COPYRIGHT, November, 1913

BY
F. A. DAVIS COMPANY

Copyright, Great Britain, All Rights Reserved



Philadelphia, Pa., U. S. A.

Press of F. A. Davis Company

1914-16 Cherry Street



PREFACE TO FOURTH EDITION.



Since the publication of the last (third) edition many
important advances have been made in surgical technique. These
have been incorporated and fully described in. the present edition.
Much new matter and many new illustrations have been added.
The minor operations have also been carefully considered and
accurately described in this edition.

In the selection of individual operations the author has

been guided by his own extensive experience in choosing those

which have appeared to him to best accomplish the objects in

view.

John J. McGrath.



(iii)



PREFACE TO THIRD EDITION.



In the preparation of the third edition particular care has
been given to the section on abdominal surgery. This section has
been entirely rewritten and much valuable new matter added.
Many of the abdominal operations range in the class of emergency
oj)erations^ for example, for acute appendicitis, for strangulated
hernia, anastomosis of bowel, etc. These operations to be suc-
cessful must be undertaken without delay and special attention
has been devoted to the accurate description of the technique of

these procedures.

John J. McG-eath.



(iv)



CONTENTS.



PAET I.

PAGE

General Consideeations 1-39

Ansesthesia: General anesthesia, 1; incomplete general anaesthesia 4; ad-
ministration of ana&sthetics, 5; intratracheal anassthesia, 9; local anaes-
thesia, 11; infiltration method, 13: Schleich infiltration method, 13; regional
anaesthesia, 14; spinal anaesthesia (analgesia) by stovain or tropacocain, 15.
—Division of Tissues: Division of soft parts, 15; division of bone, 16. —
Hemorrhage: Means to arrest hemorrhage, 17; natural arrest of hemor-
rhage, 17; artificial arrest of hemorrhage, 17; treatment of severe hemor-
rhage, 24. — Suture of the Tisues: Suture of the skin, 33; intracuticular
suture, 33; suture of muscle, 34; suture of tendons, 35; suture of nerves,
35; suture bone and cartilage, 35; suture of serous surfaces, bowel, etc., 37.



PART II.
Head and Face 40-201

Head: Surgical anatomy of the head, 40; of the scalp, 40; -cf the skull, 41; of
the dura mater, 53; brain, 56; of the pia mater, 65; cranio-cerebral topog-
raphy, 65. — Operations upon the Head: Trephining, 70; for depressed frac-
ture of the skull, 72; for intracranial hemorrhage, 74; decompression, 79;
temporal decompression (Gushing), 80; cerebellar decompression, 82: crani-
otomy, osteotegumentary flap method, 82; in parietal region to expose motor
area, etc., 84; to expose cerebellum and other parts in posterior fossa
(Gushing), 92; exposure of one-half of cerebellum (Krause), 94: for abscess
of brain, 96; puncture of brain and ventricles for diagnostic purposes, 97;
for tapping lateral ventricles, 98; permanent drainage of lateral ventricles
(Krause), 98; craniectomy (linear craniotomy), 100; trephining of frontal
sinus, 101. — Middle Fossa of the Skull: Extirpation of Gasserian ganglion
(Hartley-Krause), 105; Gushing, 109; Rose-Andrews, 111. — Mastoid Region
and Ear: Surgical anatomy of mastoid region, 113: anatomy of the ear, 116.
— Operations upon the Mastoid, etc.: Paracentesis of drum membrane, 122;
Wilde's incision, 122; to open and drain antrum, 122: for thrombosis sigmoid
sinus, 126; for cerebellar abscess, 127; for extradural abscess in middle fossa,
128; for temporo-sphenoidal abscess, 128. — Face: Surgical anatomy of face,
129; of skeleton of face, 130; of mouth, 132; side of face, 136; pterygo-maxillary
region, 137. — Operations upon the Face: Resection of upper jaw, 143; total
resection of both superior maxillae, 148; to drain antrum of Highmore, 148;
resection of half of lower jaw, 149; resection of half of body of lower jaw,
152; resection of entire body of lower jaw, 153; resection of part of body of
lower jaw (in continuity), 154; resection of part of body of lower jaw (not
in continuity), 156; resection of temporo-maxillary articulation, 156; division
of second and third branches of trifacial nerve (Kronlein-Lucke), 157;
operation upon the peripheral branches of the trifacial nerve, 158: injection
of the trunks and peripheral branches of the trifacial nerve, 159. — Gongenital
Deformities of Face: Development of face, 161; formation of palate.



(V)



vi CONTENTS.



PAGE

169; teeth, 170; tongue, 170; deformities of face 171; deformities in which
frontal plate is concerned, 172; lateral clefts of the upper lip, and alveolar
process and cleft palate, 172; median clefts and notches of the upper lip,
177; lateral nasal cleft, 178; oblique facial clefts, 178; deformities in which
the first visceral arch is concerned, 179; transverse facial clefts, 179; median
clefts, of lower lip, lower jaw, and tongue, 179. — Operations for Harelip,
Cleft Palate, etc.: Operations for harelip, 179; operations for incomplete
harelip, 181; operations for complete harelip, 184; operations for single, com-
plete harelip with cleft of alveolar process and advancement of the inter-
maxillary bone, 185; operation for double harelip without a prominent ad-
vanced intermaxillary bone, 186; operation for double harelip with promi-
nent advanced intermaxillary bone, 187; operation for cleft palate, 189. —
Operations upon the Lips: Excision of whole lower lip, 196; restoration of
lower lip, 196; Dieffenbach-Jaesche, 197; Bruns, 198; Langenbeck, 199;
Estlaender, 200; restoration of upper lip, 201; Estlaender, 201; Dieff en-
bach's Wellenschnitt, 201; Bruns, 201.



PAKT III.
Neck and Tongue 202-370

Surgical Anatomy of Neck: Deep cervical facia, 202; back of the neck, 205;
side of the neck, 205; anterior triangle, 208; posterior triangle, 208; sterno-
mastoid region, 208; inferior carotid triangle, 209; superior carotid triangle,
210; submaxillary triangle, 211; lingual triangle, 212; occipital triangle, 212;
subclavian triangle, 21.3; front of the neck, 214; hyoid bone, 214; supra-
hyoid region, 216; infrahyoid region, 216; laryngeal region, 218; thyroid
gland, 219; parathyroid bodies, 220; suprasternal region, 220; blood-vessels
of the neck, 221; common carotid artery, 221; internal carotid artery, 223;
external carotid artery, 224; internal jugular vein, 225; subclavian artei^,
226; inferior thyroid artery, 227; superior thyroid artery, 227; vertebral
artery, 228; cervical sympathetic nerves, 228; cervical lymph-nodes, 229. —
Operations upon the Neck: Ligation of blood-vessels, 230; common carotid
artery, 230; external carotid, 232; internal carotid, 232; subclavian artery,
233; lingual artery, 234; superior thyroid artery, 234; inferior thyroid artery,
235; facio-hypoglossal nerve anastomosis, 236; resection of cervical sym-
pathetic (Jonnesco), 237; cervical adenectomy, 240. — Operations upon the
Trachea and Larynx: Tracheotomy^ 244; tampon of trachea, 244; high
tracheotomy, 245; low tracheotomy, 247; median tracheotomy, 247; transverse
laryngotomy, 248; thyrotomy, 248; laryngectomy, 250; extirpation of half
of the larynx, 254. — Operations upon the Thyroid Gland: Partial extirpa-
tion, 255; enucleation, 258; ligation of thyroid arteries, 260; external
oesophagotomy, 260. — Operations upon the Tongue: Amputation of tongue
(Kocher), 262; extirpation of tongue with ligation of both lingual arteries,
265; extirpation of portion of tongue, 266; amputation of tongue (Regrioli-
Billroth), 266; extirpation of tongue through floor of mouth with division of
lower jaw, 267; Sedillot, 267; Langenbeck, 268; Billroth, 269.



PAET IV.
TiiOEAx 271-320

Surgical Anatomy of Thoracic Wall: Skeleton of thorax, 271; muscles of
chest wall, 274; fasciae of chest, 274; internal mammary artery, 275; dia-
phragm, 276. — Regions of Chest: Sternal region, 277; upper anterior pec-
toral region, 277; clavicular region, 278; infraclavicular region, 279; mam-



CONTENTS.



PAGE

mary region (breast), 280; lower anterior pectoral region. 282; lateral pec-
toral region, 282. — Mediastinum and Contents: Pericardium, 283; heart,
284; thymus, 287; arch of aorta, 287; pneumogastric nerves, 288; phrenic
nerves, 289; trachea, 289; oesophagus, 288; thoracic aorta, 292; vena azygos,
292; vena hemiazygos, 293; thoracic duct, 293; innominate artery, 293; left
common carotid and subclavian arteries, 293. — Pleura: Limits of pleura
indicated by lines upon chest wall, 294; anterior edge of pleura, 294; lower
edge of pleura, 29G; dome of pleura, 298. — Lungs: Root of lung, 299; lung.
300. — Operations upon the Breast: Incisions for abscess of breast, 301;
extirpation of tumors (fibroids) from mammary gland, 302; amputation of
breast (Halsted-Meyer), 302; skin grafting (Thiersch), 306; ligation of in-
tercostal artery, 307; ligation of internal mammary artery, 307. — Opera-
tions upon the Heart: Paracentesis pericardii, 307; pericardiotomy, 308;
pericardiorrhaphy, 309; cardiorrhaphy, 309. — Operations upon the Pleura:
Thoracentesis, 315; thoracotomy, 316; thoracotomy (Lloyd), 317; thoracec-
tomy (Estlaender), 318; pleurectomy (Fowler), 319.



PART V.
Abdomen and Back 321-544

Abdomen: Diaphragm, 321; posterior wall of the abdomen, 322; antero-lateral
wall of the abdomen, 323; superficial vessels of abdominal wall, 324; mus-
cles of the antero-lateral wall, 324; fascia transversalis, 328; parietal peri-
toneum, 328; deep vessels of abdominal wall, 329; regions of the abdomen,
330. — The Back: Muscles of the back, 333; erector spinas muscle, 334; quad-
ratus lumborum muscle, 335; lumbar fascia, 335; psoas and iliacus muscles,
336; spinal column, etc., 336. — Operations upon the Abdomen: Laparotomy,
339. — Operations for Umbilical and Ventral Hernia, etc. : Umbilical hernia,
347; ventral hernia, 352.— The Stomach: Surgical anatomy of the stomach,
355.— Operations upon the Stomach: Plication of the gastrohepatic liga-
ments (Beyea), 360; gastroplication, 362; infolding of wall of stomach for
ulcer, 364; gastrotomy, 364; pyloroplasty, 370; Heinecke-Mikulicz, 370;
Finney, 372; gastrostomy, 375; Ssabanajew and Franck, 376; Witzel, 376;
Kader, 379; gastrorrhaphy, 380; gastroplasty, 381; gastro-gastrostomy, 382;
gastrectomy, 384; partial atypical gastrectomy, 384; partial cylindrical
gastrectomy, 385; pylorectomy, 385; Billroth, 386, 390; Kocher, 390; Hart-
mann gastrectomy, 393; Mayo, 398; complete gastrectomy, 400.— The Small
Intestine: Surgical antomy of the small intestine, 406. — Operations upon
the Small Intestine: Enterotomy, 411; enterostomy, 412; jejunostomy
(Maydl), 414; Witzel, 416; enterorrhaphy, 416; enterectomy, 421; end-to-end
anastomosis, 423; suture (McGrath), 384; Mounsell, 427; Connell, 429;
Murphy button, 431; side- to-side, lateral anastomosis, 433; suture, 433; with
clamps, 436; with Murphy button, 436; with McGraw rubber suture, 437;
gastro-enterostomy, 437; gastro-duodenostomy, 438; gastro- jejunostomy, 438;
anterior (Woelfler), 440; suture method, 440; clamp method, 443; Jaboulay
and Braun modification, 444; posterior gastro-jejunostomy (von Hacker),
446; without a loop, 446; clamp method, 450; with Murphy button, 455; with
McGraw rubber suture, 456; Roux, 458.— Large Intestine and Vermiform
Appendix: Surgical anatomy of the large Intestine, etc., 460; caecum, 460;
vermiform appendix, 460; ascending colon, 462; transverse colon, 463;
descending colon, 463; sigmoid flexure, 463; blood-supply of large intestine,
464.— Operations upon Large Intestine: Colostomy, 464; left iliac colostomy,
465; right iliac colostomy, 470; lateral colostomy without a spur, 470; resec-
tion of caecum, 473; end-to-end anastomosis, 474; lateral anastomosis, 474;
end-to-side, lateral implantation, 475; ilio-colostomy, 475; resection of
sigmoid flexure, 476. — Operations upon Vermiform Appendix: Appendicec-



viii CONTENTS.



PAGE

tomy, 477; McBurney incision, 477; Mid-rectus incision, 478; ligature without
inversion, 480; inversion of stump witii purse-string (Dawbarn), 481; in-
version (Edebohls^, 482; for appendicular abscess, 482; for appendicitis ac-
companied by general peritoneal infection, 486; appendicostomy, 487. — ^Liver
and Gall-bladder: Surgical anatomy of the liver, 488; surgical anatomy of
the gall-bladder and bile-ducts, 490. — Operations upon Liver: Hepatotomy,
493; for abscess, 493; for hydatid cyst, 495; hepatectomy, 496; injuries to
liver, 499; omentopexy (Talma), 499. — Operations upon Gall-bladder: As-
piration of gall-bladder, 501; cholecystotomy, 501; cholecystostomy, 503;
cholecystectomy, 508; cholecyst-enterostomy, 512; cholecysto-duodenostomy,
512; suture method, 512; clamp method, 514; with Murphy button; chole-
cysto-jejunostomy suture method, 515; cholecysto-colostomy, 517. — Opera-
tions upon Gall-ducts: Cysticotomy, 517; hepaticotomy, 518; choledochot-
omy, 518; supraduodenal choledochotomy, 520; retro-duodenal choledochot-
omy, 522; removal of calculi from the common duct through duodenum, 523.
—Pancreas: Surgical anatomy of pancreas, 526. — Operations upon Pancreas:
Fat necrosis, 528; for injuries, 529; for cysts, 530; for acute pancreatitis, 532;
for tumors, 533. — Spleen: Surgical anatomy of spleen, 533. — Operations upon
Spleen: Splenotomy, 534; splenorrhaphy, 535; splenopexy, 535; splenectomy,
536. — Operations upon Spinal Column: Laminectomy, 537: lumbar puncture,
541.



PAET VI.
The Eectum 545-589

Surgical anatomy of the rectum, 545; sacrum, 545; coccyx, 546; rectum, 546. —
Operations upon the Anus and Rectum: Dilatation of the sphincter, 553;
fistula in ano, 553; for complete fistula, 554; for incomplete fistula, 555
hemorrhoids, 555; ligation and excision, 557; clamp and cautery, 559; pro-
lapsus recti, 559; sigmoidopexy, 560; resection and amputation of rectum,
562; perineal method in continuity (Dieffenbach), 564; amputation of rec-
tum (Lisfranc), 567; with preservation of external sphincter, 569; vaginal
method, 573; sacral route (Kraske), 573; resection of rectum in continuity —
sacral "vor operation," 574; resection of diseased portion of rectum, 576;
anastomosis of the ends of the bo-syel, 580; amputation of rectum, including
anal portion, 581; combined method (abdomino-perineal, abdomino-anal),
581; combined operation with establishment of artificial anus, 582; com-
bined operation with suture of the end of sigmoid to anal margin or anal
portion, 586; with suture of bowel to anal margin, 586; with anastomosis
of end of sigmoid to lower anal portion, 587.



PART VII.
Hernia, Spermatic Cord, Testes, etc ■. 590-649

Surgical anatomy of groin, 590; superficial layer of superficial fascia, 590;
lymphatic glands, 591; deep layer of superficial fascia, 591; inguinal region,
591; descent of the testes, 599;- femoral region, 604; study of inguinal and
femoral region from within the abdomen, 608; inguinal region, 608; femoral
region, 612.— Operations for Hernia: Herniotomy, 615; for inguinal hernia
(Bassini), 618; for inguinal hernia (Halsted), 626; for femoral hernia, 629;
for undescended testes, 630.— Spermatic Cord, Scrotum, etc.: Spermatic
cord, 6.34; scrotum, 636; testes, 636; ejaculatory ducts, 638.— Operations upon
Spermatic Cord, Scrotum, etc.: For varicocele, 638; for hydrocele, 642;
castration, 648.



CONTENTS. ix

PART VITT.

PAGE

ITrixary System 650-705

Kidneys: Surgical anatomy of kidney, 650. — Operations upon the Kidney:
Nephropexy, 655: for perinephritic abscess, 659; nephrotomy, 659; nephro-
lithotomy, 661; nephrectomy, 662; decortication of kidney (Edebohls), 665. —
Operations upon the Ureter: Ureterolithotomy, 666; uretero-ureterostomy,
668; uretero-cystostomy, 669; uretero-enterostomy, 671. — Bladder: Surgical
anatomy of bladder, 671.— Operations upon Bladder: Suprapubic cystotomy,
674; puncture of bladder, 676. — Penis: Surgical anatomy of the penis, 677.
— Operations puon the Penis: Forcible dilatation of prepuce, 675; dorsal
section, 679; circumcision, 680; circumcision with clamp, 681; amputation of
penis, 681. — Perineum and Ischio-rectal Region: Floor of pelvis from with-
out, 682; ischio-rectal region, 683; perineum, 684; pelvic cavity from within,
687. — Operations upon Perineum, etc.: Perineal section with a guide, 689;
perineal section without a guide, 690; median lithotomy, 690; lateral
lithotomy, 692. — Prostate: Surgical anatomy of prostate, 692. — Operations
upon Prostate: Prostatectomy, 696; suprapubic prostatectomy, 696; perineal
prostatectomy, 698; prostatotomy (Bottini), 703.



PAET IX.
The Upper Extreaiity 706-749

The Axilla: The axilla, 706; the axillary artery, 706.— The arm: Vessels
of the arm, 709; the brachial artery, 709; the radial artery, 712; the ulnar
artery, 714; musculo-spiral nerve, 715; median nerve, 715; ulnar nerve, 715.
— The Hand: Nerve-supply of the hand, 716; ligations, 716; axillary, 716;
brachial, 717; radial, 719; ulnar, 719. — Amputations, Resections, etc.: Sur-
gical anatomy of hand, 719; phalango-phalangeal joints, 719; metacarpo-
phalangeal joints, 720; exarticulation of the finger at the phalango-phalan-
geal joint, 720; exarticulation of finger at the metacarpo-phalangeal joint,
722; exarticulation of hand at the carpo-metacarpal articulation, 723; sur-
gical anatomy of wrist-joint, 725; exarticulation of hand at wrist-joint, 726;
amputation through forearm, 727; surgical anatomy of elbow-joint, 728;
exarticulation of forearm at elbow-joint, 730; amputation of arm, 731; sur-
gical anatomy of shoulder-joint, 733; exarticulation at shoulder-joint
(Spence), 735; exarticulation at shoulder- joint (Esmarch), 737; exarticula-
tion at shoulder-joint with deltoid flap, 739. — Resections: Wrist-joint, 742;
elbow (Langenbeck), 744; shoulder, 746; tendon suture, 749; nerve suture,
749.

PAET X.
Lower Extremity 750-825

Thigh: Gluteal region, 750; stretching sciatic nerve, 751; anterior femoral
region, 753; internal saphenous vein, 753; femoral artery, 754; anterior cru-
ral nerve, 757; ligation of femoral artery, 757; popliteal space, 760. — Leg:
Anterior tibial artery, 761; anterior tibial nerve, 762; posteiror tibial artery,
762; posterior tibial nerve, 765; ligation of posterior tibial artery, 765;
tenotomy, 765. — Operations for Varicose Veins: Internal or long saphenous,
766; external or short saphenous, 766; Trendelenburg operation, 767; Schede's
operation, 767; Madelung's operation, 769; varicose ulcer, 769. — Amputations,
Resections, etc.: Surgical anatomy of skeleton of foot, 770: exarticula-
tion of big toe, 772; exarticulation of big toe with removal of first meta-
tarsal, 772; exarticulation of little toe, 773; for bunion, 773; for hammer-



CONTENTS.

PAGE

toe, 774; for ingrowing toe-nail, 775; amputation tlirough tarso-metartarsal
articulation (Lisfranc), 775; amputation through medio-tarsal articulation
(Chopart), 778; surgical anatomy of ankle-joint, 779; exarticulation of foot
at ankle-joint (Syme), 780; exarticulation of foot, etc. (Pirogoff), 782;
amputation of leg, 784; amputation of leg with lateral hooded flaps, 784;
surgical anatomy of knee-joint, 787; exarticulation of leg at knee-joint
(Stephen Smith), 790; transcondylar amputation (Garden), 792; amputation
of knee (Gritti-Stokes), 794; amputation of thigh, 795; surgical anatomy of
hip- joint, 797; exarticulation of thigh at hip (Wyeth), 800; exarticulation
of thigh with preliminary ligation of common femoral, 803. — Resections:
Ankle (Langenbeck-Hueter), 803; ankle (Koenig), 807; ankle (Lauenstein),
809; ankle, osteoplastic (Mikulicz-Wladimirow), 810; knee-joint, 812; hip-
joint (Langenbeck), 817; plating for fracture (Lane), 821; of patella, 822;
osteotomy, 824.



LIST OF ILLUSTRATIONS.



FIG. PAGE

1. Gwathmey's Three-bottle Apparatus, Mask and Tube 6

2. Lumbard's Nasal Tubes 7

3. Mouth-gag with Perforated Tubes along Blades 8

4. Junker Chloroform Apparatus 9

5. Division of the Skin by Transfixion 16

6. Esmarch Bandage and Constrictor 18

7. Trendelenburg Position 20

8. Square Knot 23

9. Slip Knot ■ - ,.. 23

10. Surgeon's Knot 23

11. Superficial Vein Exposed for Saline Infusion 25

12. Arterio-venous Transfusion 26

13. Arterio-venous Anastomosis, Suture Method 28

14. Crile's Cannulas 29

15. 16, 17, 18. Arterio-venous Anastomosis with Crile's Cannula, etc 29, 30, 31

19. Brewer's Transfusion Tubes 32

20. Intracuticular Suture 34

21. Suture of Tendon 35

22. Bone Drill with Eye Near the Point to Carry Suture, etc 36

23,24. Segment of Bowel— Lembert Sutures 36

25. Cushing Suture 37

26. Halsted's Intestinal Suture 37

27. Non-penetrating Suture 38

28. Side of Skull '. 43

29. Transverse Section through the Anterior Fossa 45

.30. Base of the Skull from Within 47

31. Middle Fossa showing the Position of the Gasserian Ganglion' 50

32. Cross-section through Middle Fossa Just Anterior to the Position of Gasserian

Ganglion 51

33. Schema showing Parts Derived from the Three Original Brain Vesicles 57

34. External Surface of the Cerebrum 58

35. Surface of Cerebrum from above 59

36. Showing the Motor Area, etc 60

37. Internal Surface of the Cerebrum 61

38. Under Surface of the Cerebrum 62

39. Section through Scalp, Skull, Brain, etc 63

40. Chiene's Schema to Locate the Fissure of Rolando, etc 65

41. Rolandic Angle 66

42. Kronlein's Schema, to Locate the Fissure of Rolando, etc 67

43. Kocher Craniometer 68

44. Various Fissures, etc., Indicated by Kocher Craniometer 69

45. Doyen Perforator and Burr 70

46. Hudson's Trephining Instruments 71

47. Depressed Fracture of the Skull 73

48. Hartley Chisel 74

49. 50. Temporary Resection of the Skull 75, 76

51. Hudson-De Vilbiss Bone-forceps 77

52. Incision for Temporal Decompression 80

53. Decompressive Operation in Temporal Region (Cushing) 81

54. Location of Various Skull Flaps (Mills) 83

55. Kredel's Blocks in Position 85

(Xi)



xii LIST OF ILLrSTRATIOXS.

FIG. PAGE

56, 57. Formation of the Osteo-tegumentary Flap (Marion) 86, 87

58. Marlon Separator and Conductor 88

59. Formation of the Osteo-tegumentary Flap (Marion) 89

60. Doyen Guarded Chisel 90

61. Exposure of Cerebellum 93

62. Gushing Cross-bow Incision 94

63. Exposure of One-half of the Cerebellum (Erause) 95

64. Drainage of the Lateral Ventricle 99

65. Frontal Sinus 103

66. Hartley-Krause Operation 107

67. Zygomatic Arch Resected (CusJiing) 109

68. Resection of the Gasserian Ganglion, etc Ill

69. Side of Skull 115

70. Right Membrana Tympani Viewed through the Auditory Canal 117

71. Section through the Right Temporal Bone 119

72. Simple Mastoid Operation 125

73. 74. Pterygo-maxillary Region 139, 141

75,76. Resection of Upper jaw , 144,145

77. Incision for Resection of the Temporo-maxillary Joint 155

78. Points of Injection of the Superior and Inferior Maxillary Branches 159

79. Transverse Section of the Head End of an Embryo Twelve Days Old 162

80. Sagittal Section of the Head End of an Embryo Twelve Days Old IBS

81. 82. Face of Embryo, Fifth TS'eek 164, 165

83. Embryo about Fourth Week, seen from Side 166

84. Embryo about Eighth Week 167

85. Face of Embryo about Eighth Week 169

86. Diagram of Congenital Facial Clefts 171

87. Double Complete Harelip 173

88. Harelip with Advanced Intermaxillary Portion 174

89. Double Cleft Palate with Advanced Intermaxillary Portion Carrying Sockets of

Two Incisor Teeth 175

90. Oblique Facial Cleft Extending into the Temporo-frontal Region 176

91. Incomplete Oblique Facial Cleft 177

92. Transverse Facial Cleft 178

93. Simple Paring of the Edges of the Notch for Incomplete Harelip 180

94. Imperfect Result After Simple Paring and Suture 180



Online LibraryJohn J. (John Joseph) McGrathOperative surgery, for students and practitioners → online text (page 1 of 73)