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of the sphenoid bones. These fractures may be of both the complete 

 and the incomplete kind, which indeed is usually the case with those 

 of the flat bones, and they are liable to be complicated with lacera- 

 tions of the skin, in consequence of which they are easily brought 

 under observation. But Avhen the fact is otherAvise and the skin is 

 intact, the diagnosis becomes difficult. The incomplete variety may 

 be unaccompanied by any special symptoms, but in the complete kind 

 one of the bony plates may be so far detached as to press upon the 

 cerebral substance with sufficient force to produce serious nervous 

 complications. When the injury occurs at the base of the cranium 

 hemorrhage may be looked for, with paralytic symptoms, and when 

 these are present the usual termination is death. It may still happen, 

 however, that the symptoms of an apparently very severe concussion 

 may disappear, with the result of an early and complete recovery, and 

 the surgeon will therefore do well to avoid undue x>recipitation in 

 venturing upon a prognosis. In fractures of the orbital or the zygo- 

 matic bones the danger is less i)i'essing than with injuries otherwise 

 located about the head. The treatment of cranial fractures is simple, 

 though involving the best skill of the experienced surgeon, AVhen 

 incomplete, hardly any interference is needed; even plain bandaging 

 may usually be dispensed with. In the complete variety the danger 

 to be combated is compression of the brain, and attention to this 

 indication must not be delayed. Tlie means to be employed are the 

 trephining of the skull over the seat of the fracture and the elevation 

 of the depressed bone or the removal of the portion which is causing 

 the trouble. Fragments of bone in comminuted cases, bony exfolia- 

 tions, collections of fluid, or even i)rotruding portions of the brain 

 substance must be carefully cleansed away, and a simple bandage so 

 applied as to facilitate the application of subsecjuent dressings. 



Fractures of ilie hones of the face. — In respect to their origin — usu- 

 ally traumatic— these injuries rank with the preceding, and are com- 

 monly of the incomplete variety. They may easily be overlooked and 

 may even sometimes escape recognition until the reparative i)i'ocess 

 has been well established and the discovery of the wound becomes 

 due to the prominence caused by the presence of the provisional 

 callus which marks its cure. When the fracture is complete it will 

 be marked l)y local deformit}', mobility of the fragments, and crepi- 

 tation. Xasal hemorrhage, roaring, frequent sneezing, loosening or 

 loss of teeth, difficulty of mastication, and inflammation of the cavi- 

 ties of the sinuses are varying complications of these accidents. The 

 ol)ject of tlie treatment should be the restoration of the depressed 

 bones as nearly as possible to their normal position, and their reten- 

 tion in place by protecting splints, which should cover the entire 

 facial region. And 8i:)ecial precautions should be observed to prevent 

 the patient from disturbing the dressing by rubbing his head against 

 surrounding objects, such as the stall, the manger, the rack, etc. 



