10 



C. WINKLER. THE CENTRAL COURSE 



the wound, the vena jugularis externa, "that is generally much 

 swollen by the turning of the head. (See fig. 1). This vena is sup- 

 plied with blood by several venae from the face and from the 

 auricle of the ear. Inconvenient among these may be the venae reaching 

 the vena jugularis along the underjaw and also the venae auricu- 

 lares, especially the vena auricularis posterior. 



In the cranial part of the operative lesion is found the Nervus 

 facialis, crossing the area of operation (See fig. 1). 



First of all the vena jugularis has to be put aside. With a 

 small blunt hook it is detached so far that it may be pushed 

 behind the angulus maxillae inferioris. The venae auriculares poste- 



riores are stretched by this 

 proceeding, and it is there- 

 fore advisable to cut them 

 between two ligatures, be- 

 cause rupture and bleeding 

 / F in a later stage of the ope- 

 ration are to be avoided. 

 With a blunt wound-hook 

 the vena jugularis is now 

 kept behind the ascending 

 branch of the underjaw 

 and both together are drawn 



aside by an assistant. Du- 

 ring the further course of 

 the operation this vena is 

 seen no more. 



Next the N. facialis has 

 to be taken care of. This 

 nerve , after having been 

 isolated on the surface , is 

 lifted upward by an assistant 

 cautiously by means of a 

 blunt wound-holder. 



I don't hold it necessary 

 to section the nerve in 

 order to avoid degeneration 



in central direction, as has been done by VAN GEHUCHTEN. 

 If carefully treated, there need not arise a degeneration. If the 

 nerve be sufficiently protected , this does not occur , and the impor- 

 tant advantage gained in this way is that no post-operative para- 

 lysis of the muscles of the face has to be combated. Once the 



B 

 Fig. 1. 



The skin and the superficial fascia being cleft, the 



situation of the venae appears. 



A maxilla inferior . B vena maxillaris, C vena jug. ext., 

 D vena auric, lat. , >,' N. facialis, F r. auric. N. facialis, 

 G vena auric, ant., // vena facialis, / r. zygom. N. facirlis. 



