DECAPITATION. 205 



48. DECAPITATION. 



Objects. The facilitation oF repulsion and correction of 

 the deviation of fetal parts. The operation is generally car- 

 ried out when the fetal head is far advanced in the pelvic 

 canal or has passed beyond the vulva. 



Technic. Attach a cord to the inferior maxilla or around 

 the neck of the fetus and have one or more as,sistants draw 

 the head out as far as possible. 



Some obstetrists have found difficulty in applying traction 

 to the inferior maxilla by means of a cord. First make a 

 perforating wound with the knife between the rami of the 

 lower jaw, then carry the looped cord over the jaw and push 

 it beyond the perforating incision with the loop resting 

 within the month and finally pass the free end of the cord 

 through the perforation from the buccal cavity outwards, 

 and drawing upon this the inferior rnaxilla is so engaged 

 that it will permit the application of powerful traction. 



Make a circular inci,sion through the integument encir- 

 cling the head at a convenient point and separate the skin 

 backward toward the occiput by forcing the hand between 

 it and the bones or by using the chisel as a spatula 

 or dissecting it away with the Colin's scalpel, continuing 

 the separation over the occiput to the atloid region. Make 

 a transverse incision below across the trachea and oesophagus 

 and surrounding muscles and above. through the ligamentum 

 nuchae. Grasp the head firmly with both hands and twist 

 it forcibly on its long axis rupturing the articular ligaments 

 and the remaining muscles and other soft tissues, detaching 

 the head at the occipito-atloid articulation. The removal 

 of the head greatly diminishes the bulk of the fetus and it 

 may now be repelled, or deviated parts brought into the 

 desired position or other operations performed. 



