TRIFACIAL NEUROTOMY. 55 



10. TRIFACIAL NEUROTOMY. 

 Plate X. 

 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 muslin 12 cm. square. 



Technic. Secure in lateral recuratiency, preferably upon 

 the operating table, and produce complete anaesthesia. Re- 

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

 disinfect an area S to 10 cm. square over the infra-orbital 

 foramen. lyocate by touch the infra-Orbital foramen, lOF,. 

 Plate X, below the levator labii superioris proprius muscle 

 and displace this shghtly. 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 

 supierior to the foramen and near its nasal border and make 

 a wound downward and forward in the direction of the 

 comraisure of the lips about 5 cm. long through the skin, 

 muscle and connective ti,ssue 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. Some times it may be well to ligate these 

 vessels prior to making the incision. 



Hold the lips of the wound apart with two tenacula, disect 

 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- 

 rating 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 disect away about 

 5 cm. of the trunk and excise. Be ve'ry careful to include 

 all branches and especially one or two superior or dorsal 



