. Regional anesthesia : its technic and clinical application . Fig. 87.—Inferior laryngeal block The needle is inserted at the thyroid notchand follows the inner surface of the thyroid cartilage, obliquely downward, backward,and outward to the cricothyroid groove. When blocking both the superior and inferior laryngeal nervesthe needle may be passed through a single wheal raised on the midlineat the thyroid notch (Figs. 88 and 89). The superior laryngeal block is indicated for total laryngectomy andin the palliative treatment of tuberculous laryngitis. For therapeuticpurposes alcoholic solution
. Regional anesthesia : its technic and clinical application . Fig. 87.—Inferior laryngeal block The needle is inserted at the thyroid notchand follows the inner surface of the thyroid cartilage, obliquely downward, backward,and outward to the cricothyroid groove. When blocking both the superior and inferior laryngeal nervesthe needle may be passed through a single wheal raised on the midlineat the thyroid notch (Figs. 88 and 89). The superior laryngeal block is indicated for total laryngectomy andin the palliative treatment of tuberculous laryngitis. For therapeuticpurposes alcoholic solutions of cocain are preferred to the novocain- BLOCKING OF CRANIAL NERVES II5 adrenalin solutions used for surgical anesthesia. The solution recom-mended by Canuyt gives entire satisfaction. It is composed of: Cocain hydrochlorid 10 cgm. Alcohol (80 per cent.) 10 of which 2 are injected each time. The injections are made onboth sides, if necessary, and may be repeated as often as required with- 5up Larunoeal n ThurohLjod rnembroneliLjOd bore Omohyoid. ^al^ block from a single point of entrance at thethyroid notch. Front view. out any ill-effects, provided the solution is fresh and pure. A warmsolution is more active than a cold one. Inferior or Recurrent Laryngeal Block (Blocking of the Inferior or Recurrent Laryngeal Nerve) The inferior or recurrent laryngeal nerve differs on the two sidesin the early part of its course; but where the nerve becomes accessible ii6 REGIONAL ANESTHESIA to the needle, its anatomic relations are identical on both sides. Afterreturning to the neck, both recurrent nerves occupy the groove betweenthe esophagus and trachea and enter the larynx at the lower margin ofthe cricoid cartilage, after dipping beneath or perforating the lower edgeof the inferior constrictor of the pharynx (Fig. 89). They supply all themuscles of the larynx with
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