Atlas of Forensic Pathology

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ATLAS OF FORENSIC PATHOLOGY

INTRODUCTION Depending upon the circumstances of the death, additional procedures that are not routinely conducted during the course of a standard autopsy may be useful in certain situations. These special dissections include examination of the middle ears and optic nerves and eyes (both examinations are most frequently performed in infants as part of the evaluation of deaths suspicious for inflicted trauma), dissection of the vertebral arteries, dissection of the anterior or posterior neck musculature, removal of the cervical vertebral column (in infants), dem onstration of a pneumothorax, dissection of the back or lower extremities, dissection of the sinoatrial and atrioventricular nodes, and eversion of the esophagus for varices.

DISSECTION OF MIDDLE EARS WHEN PERFORMED

During the autopsy of infants the middle ear is most commonly opened to assess for the presence or absence of inflammation. While pus can be identified upon gross examination, if necessary, microscopic examination of the region could be performed to confirm the presence of a neutrophilic infiltrate. In an adult with meningitis, the middle ear can also be opened as one method to identify the source of the infection. HOW PERFORMED Using the bone saw, a wedge of the petrous ridge is removed to expose the middle ear (Figure 31.1). DISSECTION OF OPTIC NERVES AND EYES WHEN PERFORMED When the optic nerves and eyes are examined, it is almost always in the context of a sus picious infant death. In addition, office policies and forensic pathologist preference may determine when the optic nerves and eyes are examined. HOW PERFORMED To examine the optic nerves alone all that must be done is to remove the orbital plate above the eye, which is done with a bone saw in a triangular cut with the apex distal. The optic nerve is then dissected from the surrounding adipose tissue and skeletal muscle (Figure 31.2). This procedure can be performed routinely in all infant autopsies, as it would

Figure 31.2. Dissection of the optic nerves. A small triangle of bone from the orbital roof is removed. The optic nerves are exposed by dissecting away the surrounding adipose tissue and muscles. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

Figure 31.1. Dissection of middle ear. To expose the middle ear, a small wedge of the petrous ridge can be removed.