Embryotomy 643 



head is inexpedient or impossible, and the amputation of the head 

 is made advisable or necessary in order that the fetal body may be 

 repelled and the deviated extremity brought into position. 



Technic. Attach a cord to the inferior maxilla, as shown in 

 Fig. 108, or around the neck of the fetus, or fix a blunt hook in 

 the orbit, and have one or more assistants draw the head out as 

 far as possible. 



Make a circular incision through the integument, encircling 

 the head at a convenient point, and separate the skin backward, 

 by forcing the hand between it and the bones or by using the 

 chisel or spatula or dissecting it away with a scalpel, continuing 

 the separation over the occiput to the atloid region. Make a 

 transverse incision below, across the trachea and esophagus and 

 surrounding muscles, and above through theligamentum nuchae. 

 Grasp the head firmly with both hands, flex it upon the neck, 

 and twist it forcibly on its long axis, rupturing the articular lig- 

 aments and the remaining soft tissues, detaching the head at the 

 occipito-atloid articulation. The removal of the head greatly 

 diminishes the bulk of the fetus ; the remnant may now be re- 

 pelled, the deviated parts brought into the desired position, or 

 other operations performed. 



b. Cephalotomy. When the fetal head has not advanced 

 far into the pelvic canal or cannot enter the pelvic inlet on ac- 

 count of the comparatively large size of the head, when the pelvis 

 is narrowed by a tumor or callus, or when the fetal head is grossly 

 enlarged because of hydrocephalus, it may become necessary 

 to diminish the size of the head, though it is not in a position to 

 be amputated. 



Technic. In these cases the head is usually so firmly en- 

 gaged in the canal that no further fixation is necessary. After 

 thoroughly cleansing and disinfecting the parts, inject a copious 

 amount of tepid lysol solution into the vagina. Carry the ob- 

 stetric chisel into the passage, carefully guarded in the hand, 

 and place it accurately upon that part of the head of the fetus 

 where it is desired to begin the operation, generally on the me- 

 dian line of the nose with the blade of the chisel standing parallel 

 to the septum nasi of the fetus. Holding the blade of the chisel 

 firmly against the part, with the hand in such a position as to 

 effectively guard the instrument from slipping aside and wound- 



