48 TRIFACIAL NEURECTOMY 



11. TRIFACIAIi NEURECTOMY 



Fig. 16 . - ^ 



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 gauze 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. lyocate by touch the infra-orbital foramen lOF, 

 Fig. 16, below the levator labii snperioris proprii muscle 

 and displace this slightly upward toward the median line of 

 the nose 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 

 commissure 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 

 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 tenacula 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 lifting 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 sepa- 



