THE SKULL. 



Fracture through the middle cerebral fossa may pass through the body of the 

 sphenoid or basilar process of the occipital bone and cause bleeding into the mouth. 

 It may also cause an accumulation of blood behind the posterior wall of the pharynx, 

 pushing it forward. When it passes through the petrous portion of the temporal 



Anterior branch 

 piercing the bone 



Posterior branch 



Posterior meningeal 

 from vertebral 



Middle meningeal 

 FIG. 23. Middle and posterior meningeal arteries supplying the interior of the skull. 



bone, as is frequently the case, it may involve the external auditory ineatus and 

 bleeding from the ear will result. 



Fractures through the posterior cerebral fossa may cause bleeding into the struc- 

 tures of the back of the neck. This is not common. 



Middle Meningeal Hemo rrhage. Bleeding from the middle meningeal artery, 

 epi- or extradural hemorrhage, occurs in those fractures which pass through the region 



External angular process 



Anterior branch of 

 middle meningeal 



Posterior branches of 

 middle meningeal 



FIG. 24. Points of trephining for hemorrhage from the middle meningeal artery. The course of the artery has been 



marked on the outer surlace of the skull. 



of the pterion. This point is the junction of the coronal and sphenoparietal sutures, 

 about 4 cm. ( i y? in. ) behind and slightly above the external angular process of the 

 frontal bone. The middle meningeal artery comes up through the foramen spinosum 

 and then goes forward, upward, and outward to the lower anterior angle of the 



