Head and Neck. 401 



Ligation of the Arteries. The supra-orbital may be 

 ligated through an incision similar to that for exsection 

 of the supra-orbital nerve, viz., by means of an incision, 

 about one-half or three-quarters of an inch in length, and 

 so placed, that its centre will be opposite to the foramen at 

 ~the junction of the inner and middle thirds of the supra- 

 orbital margin. After division of the skin, superficial fascia 

 and orbicularis muscle, the supra-orbital artery and nerve 

 are exposed, the nerve lying to the inner side of the artery, 

 when the latter is isolated and ligated. The superficial 

 temporal may be ligated just in front of the pinna of the 

 ear, where it crosses the root of the zygoma, and through 

 an incision, about one inch in length, dividing the skin, 

 Superficial and deep fasciae, and, since the order of the 

 structures here is, from behind forwards, nerve, vein and 

 artery, the needle, in ligating the artery, should be passed 

 from behind forwards. The occipital artery may be li- 

 gated, in the occipital region, through an incision carried 

 upward and backward from the tip of the mastoid process, 

 dividing the skin, superficial fascia and nerves, the sterno- 

 mastoid and the splenius capitus muscles. 



Injuries and Diseases of the Scalp. Wounds. 

 There is very little gaping in wounds of the scalp be- 

 cause of the close union existing between the integument 

 and the epicranial aponeurosis, referred to above. Haemor- 

 rhage is often profuse in scalp wounds, because of the fact 

 that the outer coats of the arteries are intimately adherent 

 to the fibrous tissue of the superficial fascia, so that retrac- 

 tion is prevented and the application of haemostatic forceps 

 rendered difficult. Should the wound be transverse and in- 

 volve the aponeurosis of the occipito-frontalis muscle, the 

 gaping is much more marked than if the wound were a 

 longitudinal one, and, when the aponeurosis of this muscle 

 is divided, there is great danger of the inflammatory pro- 



