Image from page 491 of "Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental p
Title: Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice
Publisher: Philadelphia : W.B. Saunders Co.
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library
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remarkable in this patients case to find that theextensive manipulations which were essential to the removal of thetumor could be carried out while the patient was perfectly conscious,and was chatting and taking a lively interest in the progress of theoperation. Numerous other cases could be mentioned in our own practice, aswell as in that of others, but the above will suffice to illustrate the 4»4 LOCAL ANESTHESIA technic and possible extent of many cranial and intracranial opera-tions. In Fig. 151 is outlined the operative area for subtemporaldecompression, the deep parts to be anesthetized as indicated by theheavy dots. In this area it would, however, seem best to inject thegasserian ganglion. In Fig. 152 is figured the operative area and pointsof injection for operations upon the occipital region, as well as for ex-posing the surface of the cerebellum. To locate the supra-orbital, infra-orbital, and mental foramina,Gray gives the following directions: The supra-orbital foramen is
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Fig. 151.—Points of injection and line of infiltration for craniotomy in temporal region. (From Braun.) situated at the junction of the internal and middle third of the supra-orbital arch, between the internal and external angular processes.If a straight line is drawn from this point to the lower border of theinferior maxillary bone, so that it passes between the two bicuspidteeth in both jaws, it will pass over the infra-orbital and mental for-amina, the former being situated about 1 cm. (finch) below the marginof the orbit, the latter varying in position according to the age of theindividual. In the adult it is midway between the upper and lowerborders of the inferior maxillary bone, in the child it is nearer the lower THE HEAD, SCALP, CRANIUM, BRAIN, AND FACE 485 border, and in the edentulous jaw of old age it is close to the uppermargin (Fig. 158). The infra-orbital and mental nerves can be reached at the foraminathrough the mouth or from without for paraneural injections. Thein
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