JN1VER% DNV-SOl^ THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES GIFT OF Dr Annette Howell -ri UNIVERSE -UNIVER% THE SURGICAL ANATOMY AND OPERATIVE SURGERY OF THE MIDDLE EAR THE SURGICAL ANATOMY AND OPERATIVE SURGERY OF BY A BROCA SURGEON TO THE TROUSSEAU HOSPITAL SUPEBNUMEBAB\ PBOFESSOB TO THE FACULTY OF MEDICINE OF PARIS TRANSLATED BY MACLEOD YEARSLEY, F.R.C.S SURGEON TO THE ROYAL EAR HOSPITAL, ETC LONDON REBMAN, LIMITED 129, SHAFTESBURY AVENUE, CAMBRIDGE CIRCUS 1901 The 54 Atlas O.L FIG 37 Lettering as in the preceding figures .O.L FIG 38 Behind the spine of Henle (h) a large foramen is seen leading into the petro-squamous sinus Other lettering as in the preceding figures FIG 39 The cribriform spot above the meatus in the fcetus at seven and a half months The Atlas FIG 40 Foetus of eight and a half months (left side) The antrum is opened, a probe is in the aditus, which the Note their inclination, chisels are ready to open which avoids cutting both the middle portion and elbow of the facial , tympanic ring Other lettering as in the preceding figures FIG 41 Foetus at term The auditory meatus (soft parts) is turned forwards with the pinna and has by chance carried with it the tympanic membrane, The end of to which the malleus still adheres the probe is seen between the malleus and incus Lettering as in the preceding figures 55 The Atlas FIG 42 Foetus at term Note the position of the antrum, the course of the facial and of the sinus The probe is seen passed through the aditus and engaging in the Eustachian tube Position of the sinus in relation to the asterion fontanelle P, promonZ, zygoma Pter., pterion ; Aster., asterion tory F, facial fontanelle Other lettering as in the precedOe., occipital ; ; ; ; ing figures FIG 43 The e' and the sinus are seen to be out and e", pierce the middle and inferior fossa facial respectively of danger Two pins, of the base of the skull The Atlas 57 O.L FIG 44 Made to show, from the interior of the cranium, the and e'\ of Fig 43, piercing the antrum meatus m, malleus e, incus Other lettering and 44 as in the preceding figures pins, e' ; ; ; c, of Figs FIG 45 of three years (left side) Simple uncovera depth of ing of the antrum, which is at 10 millimetres No mastoid cells, correctly millimetres thick speaking Outer table 1'5 Boy Very compact diploiic Of all the the one in which tissue subjects dissected this the sinus is nearest to the antrum is two auditory i 43 The Atlas FIG 46 Boy of of five years (right side) the deep Simple opening antrum, which is 4'5 millimetres External table millimetre thick Spine of Henle rudimentary Lettering as in the preceding figures .02 \AJ> FIG 48 FIG 47 Man of twenty-five years Horizontal section passing through the antrum, of which the inferior wall is seen, and through the be seen with attic, where the incus its short process can lying in canal of the sinus very marked one can always, from the surface of the mastoid, attack well behind and reach the antrum without wounding the sinus the aditus Bony ; Horizontal section, subject aged forty- seven External table to years (right side) antrum 16 millimetres deep millimetres Pneumatic mastoid In the attic the part seen is the inclined plane formed by the outer attic wall, partly arched by the external auditory meatus ; The Atlas 59 FIG 49 Subject of forty-seven years (right side) Frontal section, posterior view of anterior segment The form and height of the antrum are seen Note that the transtympanic portion of the aqueduct is not in the threshold, but limited at millimetre below and millimetres behind (most The frequent arrangement) canal F is only separated from the fossa G by several pneumatic cells in a very thin plate The lettering in this figure and A, antrum Figs 47 and 48 is AD, aditus ; At., attic ; L, lateral sinus E*, middle fossa fossa R, Petrous , inferior Cl, internal auditory meatus ; F, aqueduct of Fallopius ; G, : E ; ; ; ; ; FIG 50 Man of Sclerosed seventy-five years (left side) mastoid Antrum 27 millimetres deep In consequence of the thickness of the outer table, the mastoid cells, properly speaking, can only be reached by the hole P hollowed out towards the antrum P, cells in the tip; C, petrous cells, Other lettering as in the preceding figures jugular fossa Man of seventy-five years (left side), horizontal section This section passes through the antrum, aditus, and attic , where the head of the malleus can be made out Behind the premastoid plate (p) the route hollowed out to reach the antrum can be seen On account of the presence of the cells C' behind and inside the antrum, it can be easily seen, in this subOther lettering as ject, how inflammation could reach the cerebellar fossa in the preceding figures The 6o Atlas FIG 52 Man Sclerosed mastoid of seventy-five years (right side) External table in the mastoid part, properly speaking to millimetres thick ; antrum 27 millimetres deep ; numerous petrous and squamous cells It is seen how dura mater and the sinus can be laid bare has been combined with antrectomy Lettering as in the preceding figures easily the Atticotomy FIG 53 Woman of sixty years (left side) Pneumatic mastoid with large divided into two groups by a buttress following the direction of the mastoido-squamous suture Lettering as in the preceding figures cells, The Atlas 61 O.L FIG 54 Woman of sixty years (left side) The antrum has been opened at a The depth of 25 millimetres following the direction of the pin lateral sinus is millimetres distant from our track The wall of L the aditus is destroyed FIG 55 Woman On this side atticotomy comother side, the mastoid is pneumatic, the antrum 25 millimetres deep AD., aditus ad antrum Ad., external aditus L., lateral sinus of sixty years (right side) As on the pletes antrectomy ; ; The 62 Atlas FIG 56 Woman The of sixty years (right side) On side F, shaded ; exact size facial is seen to be in no AD, aditus ad the same danger antrum ; F, facial THE END BILLING AND SONS, LTD., PRINTERS, GUILDFORD u 13JKY w vvaii TI/ av UFO% UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book fB is DUE on the last date stamped below 1961 7J V Form L9-100m-9,'52(A3105)444 ,wU)S-ANGEl^ ^OF-CALIFOl? ~ O J\E-UNIVER f 1158 00374 5576 ... DNV-SOl^ THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES GIFT OF Dr Annette Howell -ri UNIVERSE -UNIVER% THE SURGICAL ANATOMY AND OPERATIVE SURGERY OF THE MIDDLE EAR THE SURGICAL ANATOMY. .. TYMPANUM AND THE CRANIUM V 33 OPENING THE CRANIUM BY THE MASTOID ROUTE THE ATLAS 35 - THE RELATIONS OF THE SINUS AND THE ANTRUM THE FACIAL NERVE - 39 47 - 51 THE SURGICAL ANATOMY AND OPERATIVE SURGERY. .. better ossicles (le The mur Anatomy Surgical 17 that is to say, the head and neck of the malleus, the short process and the body of the incus The internal wall of the attic (part of the labyrinthine