From Celsus too we learn that the trephine was driven by a thong.
Celsus and Hippocrates both remark that, as in the case of the drill, it is necessary to dip the trephine in cold water at intervals in order to cool it, lest heat sufficient to injure the surrounding bone be generated.
Celsus graphically describes the trephine and the method of its application.
The opening made by the trephine was enlarged with a pair of strong bone-forceps, so as to expose the dura mater to the extent of a full square inch.
The trephine can be set in ordinary metal handles and rotated by hand, but a surgical engine of some kind is much preferable on the score of rapidity and safety to the animal.
The most useful instrument for intracranial operations upon animals is the small nasaltrephine (Curtis) having a tooth cutting circle of 7 mm.
The circle indicates the situation of the trephine hole.
The centre of the trephinehole should be at the intersection of the median line and a line joining the posterior canthi (Fig.
In cases of depressed or punctured fracture the trephine is occasionally required (when symptoms of compression are present) for the purpose of enabling the depressed portion to be elevated.
There are certain positions where, if it is possible, the trephine should not be applied.
It is exposed by a suitable incision; the periosteum is reflected and the bone is opened up by a trephineor chisel, and the presence of an abscess may be at once indicated by the escape of pus.
The trephine was applied, and fluctuation felt beneath the exposed dura mater, which was otherwise unchanged in appearance; the membrane was divided by a trifling crucial incision, but only a small quantity of bloody serum escaped.
There was a hole in the right parietal bone, capable of admitting the point of the little finger, and many loose fragments of bone were felt lying on the dura mater; a trephine was applied, and numerous spicula were removed.
She was depleted copiously, but notwithstanding all the symptoms indicating formation of matter under the exposed bone were present, the operation of trephine was deemed inadvisable.
The operation of trephine must also be resorted to in cases of punctured fracture.
The trephine was applied, and several detached portions were removed, with some difficulty, from beneath the undepressed portion of the bone.
The size of the crown of the trephine must be varied according to the object which is in view.
If, however, the mastoid has already been opened and the lateral sinus exposed, the trephineshould be placed so that its anterior border is just behind the sinus and its upper border well below Reid’s base-line.
If preferred, an electric trephine can be used, and often pressure with the tip of a pair of nasal punch-forceps will be sufficient.
If available, the trephine may be worked by a motor, but in this case it should be remembered that the bone will be pierced more quickly than by the hand instrument.
The exposure of the field of operation is the same whether the brain is explored through a trephine opening or from an extension of the mastoid operation.
In a case of emergency he is wiser, perhaps, to trephine and drain the abscess, leaving the mastoid to be dealt with afterwards by someone competent to do so.
Either the hand trephine or Macewen’s improved pattern mounted with a guard may be used.
The trephine used should be three-quarters of an inch to one inch in diameter according as the patient is a child or an adult.
A 3/4-inch trephine was applied at the left extremity of the opening, and it was found that about a square inch of the internal table was comminuted and driven into the brain, together with several small fragments of lead.
A trephine was applied to the exposed diploë and a crown of bone removed; considerable comminution of the inner table had occurred, several large fragments having perforated the dura-mater.
A slight prominence and a fissure was discovered in the temporal bone, and over this a trephine was applied.
The trephine is more often useful in cases of non-penetrating gutter fractures where space is needed for exploration, and the elevation or removal of fragments of the inner-table.
A circular pulsating trephine opening was then to be felt beneath the flap, but no information was forthcoming as to the bullet.
A trephine crown was taken out at the posterior end of the gutter, and the surface of the brain explored, but no fragments of bone were found.
If the depressed portion is wedged then an opening should be made with the trephine and an elevating instrument called a spatumen used to relieve the pressure.
If a fracture is found the surgeon should trephine so as to relieve the brain of any pressure of blood that might be affecting it.
He was thought to excel in the treatment of fractures of the skull, for the better management of which a trephine was made in Philadelphia, under his direction, which, in his judgment, was superior to any then in use.
He urged the trephine in the treatment of epilepsy and applied it in six cases--in four of which the disease was cured.
A trephine is just like a corkscrew, only in place of the screw you have a cup of steel.
The case had almost to a certainty been smashed to pieces; still, there was a chance that the trephine had escaped injury.
The next day he decided to trephine another, who had been struck on the head by a fragment of stone, and who had been insensible for fourteen days.
I do not advise trephining in the secondary glaucoma following intumescent cataract, for in such cases the semi-fluid lens bulges into and blocks the trephine hole.
It is very difficult for one of limited experience to discuss a subject presented so ably by Lieutenant Colonel Elliot to whom we are indebted for the sclero-corneal trephine operation.
The technique of the operation is even more difficult and exacting than in the performance of the trephine operation, and it also compares unfavorably in safety.
Late or secondary infection, not unknown following iridectomy, may follow the trephine operation, and already some fifteen or sixteen cases have been reported.
In pursuance of our purpose to avoid uveal tissue, we split the cornea, and place the trephine as far forward as such splitting will allow, and we bear on the trephine in such a way that it cuts through on the corneal edge of the wound first.
