TRIFACIAL NEUROTOMY 



65 



or twisted. It is even better to ligate or compress these 

 vessels prior to severing them. 



Hold the lips of the wound apart with two tenaciila or by 

 placing a strong suture through each wound margin and 

 through the skin at a point 6 to 8 cm. distant and tying the 

 sutures tightly, dilate the wound thoroughly and dissect 

 away the connective tissue from the nerve until every part 

 of it is clearly in view. Pass an aneurism needle beneath 

 the nerve trunk and Hfting it from the bone make a search 

 for a small artery which usually passes along beneath it 

 through the foramen and if this can be found either ligate it 

 immediately at its point of emergence and again 5 cm. 

 lower down and divide between the two ligatures or 

 separating it from the nerve protect carefully against injury. 

 With a probe-pointed bistoury or scissors sever the nerve at 

 the foramen and grasping the distal end dissect away about 

 5 cm. of the trunk and excise. Be very careful to include 

 all branches and especially one or two superior or dorsal 

 twigs which are directed upward just as they emerge from 

 the foramen. After the hemorrhage has been brought under 

 complete control and all blood clots have been removed 

 cleanse the wound carefully, dust over with iodoform and 

 close with continuous sutures. 



In order to protect this first wound during the operation 

 upon the other side take the piece of muslin mentioned 

 among the needs for the operation, and folding it several 

 times in a square, place it over the wound and suture it 

 firmly at each corner to the skin. Turn the animal to the 

 opposite side and repeat the operation on the other nerve 

 except the application of the square piece of muslin which 

 is here unnecessary. If circumstances will at all permit it 

 is far safer to operate upon only one side first, allowing this 

 to heal and then operate upon the other side. 



As soon as the animal stands, remove the protective piece 

 of muslin from thp first wound, disinfect both wounds, dust 

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