. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. connec-tion with which, as we have seen above, finger-feeling can be auxiliaryonly in a portion of the cases. We need, therefore, other fixedpoints. Such a point is the depth. Before we stick the needle in wemark with the sliding catch a distance of 5 to 6 cm.; in case of forwardcurving of the cheek by a tumor, still more. We are thereby alwaysinformed as to t
. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. connec-tion with which, as we have seen above, finger-feeling can be auxiliaryonly in a portion of the cases. We need, therefore, other fixedpoints. Such a point is the depth. Before we stick the needle in wemark with the sliding catch a distance of 5 to 6 cm.; in case of forwardcurving of the cheek by a tumor, still more. We are thereby alwaysinformed as to the depth reached, and can thus protect ourselvesfrom gross errors. In the second place we must now consider adirection discernible on inspection of the whole skull*, and we have THE HEAD, SCALP, CRANIUM, BRAIN, AND FACE 593 been able by careful observation and many examinations to estab-lish as essential for the puncture of the foramen ovale the followingfixed points: i. Viewed exactly from the front (for this determination ofdirection one must, like the designer, see with one eye only, and pos-sibly with the aid of a second cannula held freely before one), thecannula introduced into the gangHon points to the pupil of the eye on. Fig. 2 2 2.—Lateral injection of second division of fifth nerve in pterygopalatine fossa. (Hartel.) the same side (Fig. 210). If we observe this rule, then we avoid de-viating outwardly into the fossa temporalis, inwardly into the tubeand pharynx region. 2. On exact lateral inspection the cannula points to the tuber-culum articulare of the zygomatic arch (Fig. 210). If we do notobserve this rule, then it may happen that we come too far forwardinto the fossa pterygopalatina, or too far back into the region of theforamen caroticum and of the foramen jugulare; the latter way, par-ticularly—namely, the introduction of the needle into the medialpart of the foramen jugulare instead of into the foramen ovale—we have several times taken wrongly on the ca
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