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FIGURE 1

ICP Lateral

From a lateral perspective, this shows an ICP bolt inserted into the space around the brain via the skull bone to facilitate continuous ICP monitoring.

FIGURE 2

Burr Hole

The ideal location of a cranial burr hole depends on the anticipated injury in the three skull bones.

FIGURE 3

Steps in Performing a Lateral Parietal Craniotomy

A. The exact location and size of the skin flap vary, depending on extent of the wound, but must not extend to the midline at the top of the skull.

B. Skin clips are placed for hemostasis, and burr holes elevate the skull bone flap.

C–D. The bone flap is removed, the dura mater is opened to expose and release an epidural hematoma, and bleeding vessels are ligated. In the absence of significant brain swelling, the skull plate is reattached once hemorrhage is controlled and other necessary procedures have been accomplished. With significant brain swelling, the dura is closed, sometimes using dural substitutes, and the bone flap is not replaced at initial operation (decompressive craniotomy).

FIGURE 4

Nasal Packing for Hemorrhage Control

Under general or topical anesthesia, gauze impregnated with Vaseline to facilitate insertion is layered into a bleeding nasal passage to achieve hemostasis. Balloon devices are commercially available to provide posterior and anterior nasal packing.

FIGURE 5

Lateral Canthotomy

This drawing of the eye demonstrates the location for creation of a lateral canthotomy in the eye covering. Note the lateral ligament, which may be cut with ocular scissors.

FIGURE 6

Anatomy of the Neck

Anterior perspective—Although usually approached from incisions just anterior to the sternocleidomastoid muscle, the surgeon must always review the cervical anatomy and its structural relationships prior to incision. The external jugular vein is a subcutaneous structure, and the internal jugular vein and carotid arteries are deep and medial in the neck.

FIGURE 7

Lateral Anatomy of the Neck

This is the anatomy of the neck as seen from a left lateral view. Note the location and course of the facial vein, the division of which is the key to exposing the mid to upper structures in the deep neck.

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