48 TRIFACIAL NEUROTOMY. 



lo. TRIFACIAL NEUROTOMY. 

 Plate IX. 



Object. The relief of iuvolnntar}' shaking of the head. 



Instruments. Razor, scissors, convex scalpel, teiiacnla, 

 aneurism needle, compression artery forceps, needles, thread, 

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



Technic. Secure in lateral recumbency, preferablj' upon 

 the operating table, and produce complete anaesthesia. Re- 

 move the halter, bridle, or other head gear. Shave and dis- 

 infect an area 8 to 10 cm. square over the infra-orbital fora- 

 men. Locate l)y touch the infra-orbital foramen, lOF, Plate 

 IX, below the levator labii superioris proprius muscle and 

 displace the latter, LIv, downwards toward the inferior maxilla 

 until the foramen can be felt above the mu.scle. By pushing 

 this mu.scle downward the branches of the glos.so-facial 

 vessels which lie chiefly below it are pushed downward with 

 the mu.scle so that the incision can be made without wound- 

 ing them. Begin the incision i cm. above the foramen and 

 carry it down directly' over the middle of the nerve a distance 

 of 5 or 6 cm., through the skin, subcutem and the levator 

 labii superioris alaque nasii muscle, laying bare the nerve 

 NF, where it emerges from the foramen. Let an assistant 

 hold the lips of the wound apart and the levator muscle 

 downwards with two tenacula, dissect away the connective 

 ti.ssue surrounding tlie nerve until the latter is clearly de- 

 fined, pass the aneurism needle beneath the nerve from 

 above downwards being especially careful to include the 

 uppermost or donsal twigs, and passing a curved probe- 

 pointed .scalpel or the blade of a pair of scissors underneath 

 it, divide the nerve at the foramen, grasp the di.stal end with 

 forceps and excise a piece at least 3 cm. long being careful 

 to include all branches. Control the hemorrhage very care- 

 fully. Cleanse the wound, sprinkle with iodoform and close 



