La pratica di chirurgia . nd dovrebbe notcoinvolgere il nervo facciale, dotto di Stenos, o la ghiandola parotide. Nowfare un'incisione trasversale sotto e parallela al condotto di Stenos verso il basso sull'osso, colpendo il ramus circa un quarto di pollice sotto la tacca thesigmoid. Esporre completamente l'osso e trephine attraverso 702 LA TESTA E LA COLONNA VERTEBRALE e attraverso. Quindi, con la pinza rongeur, gnaw via l'osso tra l'apertura del trephine e la tacca. Ora retrarre foi-ward il muscolo temporalmuscle, rimuovere le particelle ostruenti di grasso, esporre il ptery-goid esterno e ritrarlo verso l'alto, quando il linguale e inferiore ne dentale

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The practice of surgery . nd should notinvolve the facial nerve, Stenos duct, or the parotid gland. Nowmake a transverse incision below and parallel to Stenos duct downupon the bone, striking the ramus about quarter of an inch below thesigmoid notch. Expose thoroughly the bone and trephine it through 702 THE HEAD AND SPINE and through. Then, with rongeur forceps, gnaw away the bone betweenthe trephine opening and the notch. Now retract foi-ward the temporalmuscle, remove obstructing particles of fat, expose the external ptery-goid, and retract it upward, when the lingual and inferior dental nerveswill appear lying upon the internal pterygoid muscle. Secure eachnerve with a suture, draw it down, trace the nerves up to the fcu-amenovale, and divide them there. Then drag out by torsion their peripheralportions. Such are the best accepted methods of operating upon the peri-pheral parts of the trifacial nerve. After all is said, however, we mustremember that these operations frequently do little more than palliate.. Fig. 445.—Neurectomy, trifacial. Third divi.^ion (adapted from Kocher). and that the truly radical operation must be directed to the (iasserianganglion. The literature of Gasserian ganglion operations is now enormous, and the names of several well-known neurologic surgeons are associ-ated with the subject. We may not refer in general terms even to thedifferent methods advocated and the various technics employed. Suf-fice it to say that surgeons have reached the ganglion by operating fromabove and from below—by the high temporal, the median direct, andthe low pterygoid routes, and that with these routes are associated thenames of Rose and Andrews, of Hartley and Krause, and of Cushing.I am convinced that Harvey Cushings method is admirably satisfac-tory, for it preserves the nerve-supply to the brow, avoids the middle ^ Binnie gives an admirable brief description of these operations in the thirdedition of his Manual of Operative Surgery, 1907. NEURALGIA 703

Parole chiave associate all'immagine

• bookcentury1900
• bookdecade1910
• booksubjectsurgery
• bookyear1910