Operative Surgery V.1

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In a case with firmly depressed fragments (Fig. 267, d), the application of the trephine should not be delayed by attempts with less effective means.
In punctured fracture a large trephine is usually employed and so placed over the fracture, if possible, as to provide by a single button ample room for the removal of the fragments of the internal table.
The lodgment in fissures and in bony asperities of hairs, threads, etc., should be noted^ and their removal secured to prevent infection.
OPERAT
...IONS ON THE NERVOUS SYSTEM.
237 Trephining over the course of important vessels should be avoided, ex- cept for special reasons. The middle meningeal artery and its branches, and the cerebral sinuses are of special significance in this regard.
The Middle Meningeal Artery. — After entering the cranium the middle meningeal divides into two branches, anterior and posterior. The ante- rior branch runs in a canal or groove on the inner surface of the an- tero-inferior angle of the parietal bone (Figs.


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