By Karuna K. Chatterji
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Additional info for A Handbook of Operative Surgery and Surgical Anatomy. With Chapters on Instruments
The hypoglossal nerve and the lingual vein are separated from it by the hyoglossus muscle. Finally, it emerges from under the hyoglossus muscle and runs to the under surface of the tongue with a tortuous course as ranine artery being covered only by its mucous membrane (Fig. 24A). A. At its Origin Incision as for ligature of the external carotid artery and t h e operation corresponds to its ligation a t the site of election. Pass the ligature from without inwards (see Fig. 25). B. e. beneath the hyoglossus POSITION Patient is close to the edge of the table in dorsal position with the shoulder raised and face turned to the opposite side.
COLLATERAL CIRCULATION After ligature of radial or ulnar arteries : Anterior (volar) and posterior (dorsal) interosseii with anterior (volar) carpal, posterior (dorsal) carpal and recurrent branch of the deep palmar (volar) arch. Comment :—(1) Do not cut. too deep. (2) Flex and extend, pronate and supinate to determine the various muscles. (3) The direction of the fibres of the brachio-radialis and pronator radii teres (pronator teres) are vertical and oblique respectively. (4) The flexor carpi ulnaris is tendinous at its insertion on its outer (lateral) side, but has muscular fibres attached to its inner (medial) side.
The temporal muscle is split down to the pericranium on a line with the puncture made by the trephine pin. Along the edges of the split the muscle is reflected from the skull and retracted outwards and inwards ; with t h e impression on the bone as a guide, a trephine, an inch or three-quarters of an inch in diameter is applied. After the circular impression on the bone is made deep enough, the pin is withdrawn and trephine impression is deepened by steady and cautious circular movement till the dura is reached.
A Handbook of Operative Surgery and Surgical Anatomy. With Chapters on Instruments by Karuna K. Chatterji