Under The Microscope: #2 Attention! Head!

 

Attention is then turned to the head. The scalp is incised across the posterior vertex from a point behind the ear to the corresponding place on the other side. Where a Y-incision is used on the neck, the limbs of the Y may be continued right across the scalp, especially if a face dissection is necessary. The tissues are reflected forwards to the lower forehead and back to the occiput. The deep scalp tissues may peel off by traction, but often require touches of the knife to free them. Bruising is sought and, where head injuries are present or suspected, the scalp should be reflected right back to the nape of the neck, paying particular attention to the tissue behind and below each ear where injuries causing vertebrobasilar artery damage occur. Where there are facial injuries, the skin of the face may be peeled back from the jaw line and downwards from the forehead, restoration being excellent if care is taken not to perforate the facial skin during removal. The skull is sawn through, using either hand or power tools. The line of the cut should not be along- a circumference, as it is then impossible to reconstitute the head without unsightly sliding of the calvarium. There should be an angled removal, with a horizontal cut from forehead to behind the ears joined by a second, which passes diagonally upwards at a shallow angle over the occipitoparietal area. Care must be taken not to place this posterior saw-cut too vertically (and thus anteriorly) on the skull, or the brain may be damaged by forcing its removal through too narrow an aperture.

The calvarium is then removed by leverage after complete cutting through. A mallet and chisel should not be used in forensic autopsies, even to ensure that the dura is kept intact. The risk of extending or even causing fractures by the use of excessive hammering is too great merely to justify an unmarked dural membrane. A cut dura is easily recognized as such by any competent pathologist. What is more important is to inspect the surface of the exposed dura and brain and assess any oedema, bleeding or inflammatory conditions that may be present. The skull-cap is carefully inspected for fractures and the dura peeled off the inside to study the inner skull surface.

The falx may have to be cut to free the brain, then a scalpel or blunt-pointed bistoury is passed along the floor of the skull to divide the cranial nerves, carotid arteries and pituitary stalk until the free edges of the tentorium are accessible. A cut is made along each side of the tentorium, following the line of the petrous temporal bones to the lateral wall of the skull. Continuing with traction on the brain, but being careful not to impact the upper surface against the posterior saw-cut, the knife severs the remaining posterior cranial nerves and then passes down into the foramen magnum to transect the spinal cord as far down as can be reached. The hand is now slid under the base of the brain, which is rotated backwards for removal, any attached dura being severed where necessary. The brain is taken into a scale pan and weighed before either fixation or dissection.

The floor of the skull is now examined and the basal dura stripped out with a strong forceps to reveal any basal fractures. Discarded dental forceps can be usell for this purpose. The venous sinuses are incised to search for thrombosis. Where appropriate - and always in infants - the petrous temporal bones are sawn, chiseled or cut with bone forceps to examine the middle and inner ears for infection.

 

In the anterior method, the vertebral bodies are removed after complete evisceration of the body, by sawing through the pedicles by a lateral cut down each side. The advantages are that the body need not be turned over on to its face and an extensive dorsal incision is avoided, which requires subsequent repair. The author finds this method more laborious, however, especially in the thoracic region where the heads of the ribs make the approach difficult.

 

The strip of bone may be. dissected off from below upwards to expose the spinal canal. The cuts should be placed sufficiently lateral to allow the cord to be removed without difficulty. When the canal is exposed, the dura is examined for haemorrhage, infection or other abnormalities, then removed - still within its dural sheath - by transecting the nerve roots and dural attachments, and peeling it out progressively from below upwards. The dura is then carefully opened with forceps and scissors to examine the cord itself. It can be fxed in formalin, as with the brain, before cutting, or dissected immediately and samples taken for histology. Crushing, infarction, infection, haemorrhage and degeneration are the main lesions in a forensic context. The empty spinal canal must be carefully examined for disc protrusions, tumours, fractures, haemorrhage dislocations and vertebral collapse.

Where in any autopsy spinal damage is suspected, a good preliminary test is to slide the hands under the back of the eviscerated body on the autopsy table and lift the dorsolumbar spine upwards, whilst watching the interior vertebral bodies. If a fracture or dislocation is present, abnormally acute angulation will be seen, instead of smooth bending. The cervical spine can be tested by manual manipulation. If suspicious angularion is seen, a slice can be taken along with the anterior spine, through the vertebral bodies and discs, with an electric or handsaw. This will reveal the interior of the spine and exhibit any crushing, haemorrhage, or torn disc spaces: if one of these is found, the cord must always be removed.

 

Acknowledgements:

 

www.politie.nl  Politiekorpschef  @Janny Knol©

 

www.aived.nl    AIVD – @Erik Akerboom ©

 

www.politie.nl WEB Politie - @Henk van Essen©

 

https://www.police-nationale.interieur.gouv.fr/ @ Stephane Folcher ©

 

 

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