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1160 SURFACE AND SURGICAL ANATOMY. 
The lymphatics of the anterior part of the scalp jom the facial lymphatics ; those 
of the temporal and parietal regions open into the pre- -auricular and parotid 
lymphatic glands, situated in front of and below the ear, and into the post-auricular 
or mastoid glands, situated upon the insertion of the sterno-mastoid muscle. The 
lymphatics of the occipital region open into the occipital glands, which he close to 
the occipital artery where it becomes superficial in the scalp. 
Bony Landmarks of the Cranium.—At the root of the nose is the fronto- 
nasal suture (masion); a little above it is the glabella, a sight prominence which 
connects the superciliary ridges. About 1 in. below the posterior pole of the 
cranium, and 2 in. above the spine of the axis, is the external occipital pro- 
tuberance (inion). In the child the protuberance is not developed; its position 
may be defined by taking a point at the junction of the upper and middle 
thirds of a line extending from the posterior pole of the skull to the spine of 
the axis. About a third of the distance from the nasion to the inion is the 
bregma or junction of the coronal and sagittal sutures; with the head in the 
natural erect posture the bregma corresponds to the middle of a line carried across 
the vertex between the pre-auricular points of the zygomatic arches. 
At birth the position of the bregma is occupied by the anterior fontanelle, 
a rhomboidal membranous area which generally becomes ossified at about the 
eighteenth month. The size and date of closure of the fontanelle, as well as its 
tension and pulsation, are all points to be carefully noted in the clinical examina- 
tion of children. 
The lambda, or junction of the sagittal and lambdoidal sutures, situated 
24 in. above the inion, can generally be felt through the scalp; a line drawn 
from it to the posterior border of the root of the mastoid process corresponds 
to the lambdoidal suture. In the adult the parieto-occipital fissure of the brain 
hes opposite, or a few millimetres in front, of the lambda; in the child, however, 
the fissure may be as much as 1 in. in front of it. 
Crossing the supra-orbital margin close to its inner angle, a finger’s-breadth from 
the middle ime are the supra- -trochlear nerve and the frontal Irena of the ophthalmic 
artery ; the latter nourishes the flap in the operation of rhinoplasty. At the 
junction of the inner and middle thirds of the supra-orbital margin, 1 in. from 
the middle line, is the supra-orbital notch or foramen, the guide to the supra- 
orbital vessels and nerves. <A little above the level of the outer canthus of the eye- 
lid is the fronto-malar suture, immediately above which is the external angular pro- 
cess of the frontal bone. At the posterior end of the suture the temporal branch of 
the orbital nerve pierces the temporal fascia to reach the scalp. Half-an-ineh above 
the suture is the lower margin of the cerebral hemisphere ; while half-an-inch below 
the suture is a small ¢wbercle on the posterior border of the malar bone; a line 
drawn from this tubercle to the lambda gives the line of the parallel fissure and of 
the descending cornu of the lateral ventricle. 
The zygomatic arch, an important landmark, is horizontal when the head is in 
the natural position, and is on the same level as the lower margin of the orbit and 
the inion; its upper border is at, or not infrequently a little above, the level of the 
lower lateral margin of the hemisphere. The upper border of the zygoma may be 
traced backwards immediately above the tragus and the external auditory meatus 
to become continuous with the ridge formed by the supra-mastoid portion of the 
temporal crest. The part of the posterior root of the zygoma Which lies immedi- 
ately in front of the upper end of the tragus constitutes a valuable landmark 
which may with advantage be termed the pre-auricular point of the zygoma, while 
by the term post-auricular point is understood that point upon the supra-mastoid 
crest which lies immediately behind, and a finger’s-breadth below, the upper attach- 
ment of the auricle. The temporal eseels and the auriculo-temporal nerve cross the 
zygoma at the pre-auricular point, and it is here that the pulsations of the tem- 
poral artery may be felt during the administration of an aneesthetic, or the vessel 
compressed for the purpose of checking bleeding from the temporal region of the 
scalp. The termination of the auriculo- temporal nerve in the neighbourhood 
of the parietal eminence is often the seat of a neuralgic pain in irritative con- 
ditions about the external auditory meatus, the latter bemg supphed by this nerve. 
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