Primary Surgical Processing of Wounds in Craniotomy Procedures, Cheat Sheet of Medicine

Download Primary Surgical Processing of Wounds in Craniotomy Procedures and more Cheat Sheet Medicine in PDF only on Docsity! Surgeries on cranial part of the skull Name/ Ahmed Mohamed Madkour Br/ 4 Operations including • primary surgical processing of wounds in the cerebral department of the head • trepanation of the skull, • antrotomy(mastoidotomy), • frontal and muxillary sinusotomies; • incisions of phlegmons on the lateral region of the face; TREPANATION OF THE SKULL There are 2 types of skull trepanation, which are the decompressive and osteoplastic ones. Decompressive trepanation (Cushing's trepanation): It is a palliative operation. A) Indications: Raised intracranial pressure leading to tumour Oedema of the brain due to trauma B) Aim: To make a definite part of vault in defect of the skull and dura mater C) Location: It is located in the temporal region • D)Procedures: • dissection of the skin and subcutaneous tissue on the temporal region is made according to lines of attachment of the temporalis muscle • The base of the flap is opened till the zygomatic arch • The temporal aponeurosis, interaponeurotic fat and temporalis muscle are dissected vertically till the periosteum. They are separated with a raspatory into a field of 6 cm • While retracting the wound with a hook, an orifice is made by using the Duaen's trepanator in the central part which is free of periosteum. Firstly a sharp drill is applied, and then a conical-shaped drill is used. • The hole is widened with the Luer's cutter. • A lumbar puncture is performed before opening the dura mater. • Each portion of the cerebrospinal fluid withdrawn should not exceed 10-30 ml. • The dura mater is opened with a cross like dissection. • The size of the trepanated orifice depends on the intracranial pressure: A wider orifice is needed in a higher intracranial pressure. • The operative dissection is sutured layer by layer, excluding the dura mater. Osteoplasti c trepanatio n (olivecron's trepanatio n) A) Indications: Bleeding of the middle meningeal artery (urgent operation to safe the patient's life) Haematoma Tumour B) Procedures: i During trepanation, a shoe-like dissection with the base of flap is made on the zygomatic arch in order to ligate the main trunk and posterior branches of the middle meningeal artery. ii. Dissection of the skin, aponeurosis, periosteum and osteal flap is carried out in stages. iii. 1" stage: The skin, subcutaneous tissue, aponeurosis, and muscle are dissected. The length of the base of the flap must not be less than 6-7 cm, and 1 cm from the eye socket and tragus of the ear. The cutaneomusculo aponeurotic flap is pulled downwards after the bleeding stops D) Procedures: i The patient is placed in the supine position with the head turned to the unaffected side and fixed, and the ear is retracted anteriorly.ii. General or local infiltrative anaesthesia by 0.5% Novocain solution is administered. iii. The skin with subcutaneous tissue is dissected 1 cm from the auricle. iv. The periosteum and its surrounding tissues are cut, and then Shipo's triangle is exposed. V. The periosteum is retracted with a raspatory. vi. The outer layer of the bone is removed with a grooved gouge. vii. Once the antrum mastoideum is exposed, pus and granulation are removed with the Folkman's spoon. viii. Then, drainage is made. ix. Finally, the skin is sutured (depression on the skin can be seen). FRONTO- AND MAXILLAR Y SINUSOT OMY A) Indications: Inflammation of the frontal sinus Inflammation of the maxillary sinus (Highmoritis)B) Special instruments: Voyachek'ssurgical set of gouges and chisels C) Anaesthesia: Local anaesthesia can either be per os or parenteral. There are 2 methods of anaesthe sia: i. Central: It is injection of Novocain solution near the foramen rotundu m. ii. Peripher al: It is administ ered near the tuber maxillae. It is administ ered in the infraorbi tal region near the infraorbi tal artery. Ritter- Janssen's frontoto my: i. An arch- shaped dissectio n is made along the base of the nose and supraorb ital margin of the soft tissue. ii. The Voyache k's chisel is used to make a small hole on the superiom edial wall of the orbital cavity. iii. Then, the Folkman' s spoon is used to remove pus from the frontal sinus. iv. Finally, the skin is stitched. Maxillary sinustom y: i. It is also known Highmor otomy. ii. The anterior wall of the maxilla is trepanat ed. iii. The upper lip is lifted. iv. A dissectio n is made under the lip from the incisivae until the 2 and 3 upper molars. v. A hole is made in the bone by using the Voyache k cutter. o vi. The sinus is cleaned by using the physiolo gical solution drainage . vii. After that, the Folkman' s spoon is used to remove pus. * Do not damage the infraorbi tal foramen as the trigemin al nerve and orbital artery are situated nearby. *After frontal sinusoto my, the frontal sinus is fully covered by connecti ve tissues permane ntly. The sinus cavity remains after