11 topics with brief reviews: definitions, key facts, and class questions.
This section is dedicated to surgical interventions on the cerebral and facial regions of the head. It details techniques for accessing cranial cavity structures, methods for arresting hemorrhage, and principles of tissue defect repair.
The material is conventionally divided into two blocks. The first covers interventions on the cranial vault: osteoplastic and decompressive trepanation, antrotomy (mastoid trepanation), punctures, and primary surgical debridement (PSD) of cranial wounds. The second block is dedicated to maxillofacial surgery: PSD of facial wounds, opening of purulent foci, and reconstructive surgery (closure of defects with local tissues, free skin flaps, and the Filatov delayed pedicle flap).
During practical classes and exams, special attention is paid to the indications for decompressive trepanation, the technique of outlining musculocutaneous flaps, and the topography of facial nerve branches during operations for purulent processes on the face. It is essential to clearly understand the specifics of tissue blood supply when choosing a method for skin grafting.
Why are incisions made in a radial direction during access formation?
The radial direction of the incisions coincides with the natural course of the neurovascular bundles on the cranial vault. This preserves their integrity and ensures adequate blood supply to the flap.
Why cut the bone at a 45-degree angle?
With such a bevel cut, the outer surface of the flap becomes larger than the inner one. This forms a distinctive bony ledge that reliably prevents the flap from collapsing into the cranial cavity postoperatively.
What are the specific characteristics of blunt head trauma?
In blunt trauma, the inner (vitreous) lamina of the cranial vault bones suffers the most destruction, and the zone of damage is often wider than that of the outer lamina.
How to precisely determine the location for a lumbar puncture?
A horizontal line must be drawn through the highest points of the iliac crests (crista iliaca)—this will indicate the L3–L4 interspace.
Why should the lower part of the trepanation opening be covered by the zygomatic arch?
This is necessary so that the temporalis muscle, resting on the zygomatic arch, creates a solid muscular framework. This will prevent the prolapse (excessive herniation) of the edematous brain outward in the postoperative period.
What is the purpose of using a button-ended probe during surgery?
A probe with a button end is necessary for safe orientation in the wound and monitoring the opening of the mastoid antrum. It must pass through the aditus ad antrum, confirming communication with the tympanic cavity.
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