Syphilitic caries of cranium. (Bruns.)
INJURIES TO THE HEAD PREVIOUS TO AND DURING BIRTH.
In utero the head is surrounded by amniotic fluid and is well guarded against injury. Nevertheless as the result of penetrating wounds or of falls on the part of the mother real injuries do occasionally occur. Most of the cases of skull fracture reported as occurring before birth have occurred during delivery. Multiple fractures of the skull of either character have been observed.
During the process of parturition there nearly always appears a tumor of the scalp in the newborn, known as the caput succedaneum, at the point where pressure upon the head has been least. It usually disappears quickly after birth. It is due to a collection of blood, partly an extravasation, as the result of compression or injury. It is composed also of edematous soft tissues of the surface. If incised, blood-stained serum is poured out. When this fails to rapidly resorb during the first days of the infant’s existence, and especially if it fluctuate, it may be incised under antiseptic precautions and blood clot be turned out. In rare cases it suppurates, by which is produced an acute abscess, which should be promptly evacuated.
A collection of fluid blood between the periosteum and the bone is known as the cephalhematoma neonatorum, such a lesion occurring on an average once in two hundred cases. It is generally found over the fissures, and appears to be produced by the sliding of the bones. This collection also usually promptly disappears. In case of failure it may be aspirated or incised. Before resorting to any operative procedure it would be well to make a careful distinction between a possible meningocele or encephalocele, as a congenital defect, and cephalhematoma as an accident of delivery.
Fig. 372
Fracture of right frontal bone in a newborn infant; fracture extending into orbit. (Bruns.)
A depression in the skull of a newborn child which does not quickly right itself or yield to expanding influences from within should not be allowed to go uncorrected, as serious lesions ordinarily of paralytic type may result therefrom. In these days of aseptic surgery there is no reason why such operation as may be necessary to elevate a fragment or an entire bone should not be performed, with the usual precautions.