The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
=Neurectomy of the inferior dental nerve.= A transverse incision is made
through the skin and subcutaneous tissues at the level of junction
between horizontal and vertical rami of the jaw, extending from the
anterior border of the vertical ramus to the posterior border of the
same. The tissues are retracted and the masseter muscle exposed. The
muscle fibres are split in the vertical direction and the bone laid
bare. A ¹⁄₂ inch trephine is applied, and a disk of bone removed so as
to expose the inferior dental nerve at its entrance into the inferior
dental canal. The nerve is freed from the corresponding artery, divided
at the centre of exposure, and the two ends seized with forceps, twisted
and avulsed in such a manner as to destroy and remove the maximum number
of nerve-fibres. The disk of bone is replaced, the muscle fibres brought
together with a few catgut sutures, and the margins of the skin incision
approximated.
=Exposure of the infra-orbital nerve.= A curved incision is made through
the skin and subcutaneous tissues parallel to and below the
infra-orbital margin, the tissues retracted, and the small muscles
overlying the infra-orbital foramen divided or retracted so as to allow
exposure of the foramen. The nerve is isolated and divided. The
peripheral end is seized with forceps and avulsed. The central end may
be treated after similar fashion, or, preferably, again exposed in the
infra-orbital groove or canal, the tissues being peeled away from the
floor of the orbit and the nerve sought for as it traverses the
infra-orbital canal. With this object in view, it may be necessary to
gently break away the osseous roof of the canal before the nerve can be
exposed. It is then lifted up with a small hook, drawn through the
infra-orbital foramen, seized with forceps, and avulsed in such a manner
as to be torn away somewhere in the region of the spheno-maxillary
fossa. The wound is then sewn up.
=Exposure of the supra-orbital nerve.= The nerve is exposed through a
curved incision parallel to the supra-orbital margin, and so planned as
to be concealed by the eyebrow. The fibres of the orbicularis
palpebrarum are separated and the foramen identified. The nerve is
separated from its artery, divided, the peripheral portion avulsed, and
the central portion again exposed as it courses along the roof of the
orbit. For this purpose the tissues of the upper lid are detached from
the supra-orbital margin, the nerve delivered with the aid of a small
hook, brought out through the foramen, and avulsed in such a manner as
to be torn away somewhere in the region of the sphenoidal fissure. The
wound is then sewn up.
NEURALGIA MAJOR
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