The Face. 467 



Neuralgia of the fifth nerve, or trifacial neuralgia, which 

 is a disease of adult life, may be due to a variety of causes, 

 constitutional and local, and may affect one or more of the 

 trunks of this nerve. When the supra-orbital is involved, 

 the pain is felt in the distribution of this branch, and ten- 

 der spots are usually present in the following situations : 

 One, at the exit of the nerve from the supra-orbital fora- 

 men; another, occasionally present, in the upper eyelid 

 (palpebral), and a third, on the side of the nose at the 

 junction of the nasail bone with the cartilage (exit of 

 nasal). When the superior maxillary is the seat of the 

 pain, a tender spot is generally felt at the infra-orbital 

 foramen, or over the prominence of the cheek (malar). 

 When the inferior maxillary is affected, the painful spot is 

 often in front of the ear (auriculo-temporal), or at the 

 mental foramen (exit of inferior dental), or just above 

 the parietal eminence (the auriculo-temporal at its junc- 

 tion with the great occipital). 



Operations. The facial artery may be ligated 

 through an incision, one inch in length, over the point 

 where it appears on the face, i.e., at the junction of the 

 anterior border of the masseter muscle with the inferior 

 border of the jaw bone. 



Nerves. Excision or stretching of the facial portions 

 of the trifacial nerve may be performed through incisions 

 over the foramina of exit, above referred to, of the divi- 

 sions of this nerve. Should it be deemed advisable to 

 remove more of the superior maxillary nerve, the floor of 

 the orbit may be chiselled away and the nerve followed 

 backwards, through an incision placed below and parallel 

 with the lower margin of the orbit. If both the superior 

 maxillary and Meckel's ganglion require to be removed, 

 an incision, similar to that in the preceding operation, 

 may be employed, and the nerve, at its exit from the infra- 



