64 



TRIFACIAL NEUROTOMY. 



carefully through the fauces until it hooks over the posterior 

 border of the soft palate. The knife is then gently drawn 

 forward making an incision along the median line of the 

 soft palate from its posterior, free border to its attachment 

 on the palatine bone. The hand is then withdrawn and the 

 speculum removed for a few minutes to permit the patient to 

 rid its pharynx of any blood clots or mucus that may have 

 accumulated. Readjusting the speculum as before, the 

 right hand is again passed through the fauces and now that 

 the palate is divided a manual exploration may perfectly^ 

 reveal the presence of any abnormality in the region. 



11. TRIFACIAL NEUROTOMY. 



Plate XIII. 



Object. The relief of involuntary shaking of the head- 

 Instruments. Razor, scissors, convex scalpel, tenacula, 

 aneurism needle, compression artery forceps, needles, thread, 

 absorbent cotton, a strong piece of muslin 12 cm. square. 



Technic. Secure in lateral recumbency, preferably upon 

 the operating table, and produce complete anaesthesia. Re- 

 move the halter, bridle, or other headgear. Shave and 

 disinfect an area 8 to 10 cm. square over the infra- orbital, 

 foramen. Locate by touch the infra-orbital foramen, lOF, 

 Plate XIII, below the levator labii superiorisproprius muscle 

 and displace this slightly upward toward the median line of 

 the uo.se until the foramen can be clearly felt below the 

 muscle. With the scalpel begin an incision somewhat 

 superior to the foramen and near its nasal border and make 

 a wound downward and forward in the direction of the 

 commisure of the lips about 5 cm. long through the skin, 

 muscle and connective tissue down to the nerve and control 

 hemorrhage with the greatest care. If the larger branches- 

 of the glosso-facial vessels are severed they should be ligated 



