. Regional anesthesia : its technic and clinical application . clined upward and frontward. In case of alcohol injec-tion, the nerve must be located before injection is commenced. Pares-thesias in the upper jaw, or teeth, indicate that the nerve has been hit,in which case the anesthesia is almost immediate. For surgical pur-poses it is not necessary to make intraneural injections, since they areoccasionally followed by severe pain lasting several days and evenweeks. Injection into the sphenomaxillary fossa of large quantities of ^fluid are likely to be followed by exophthalmos, edema of the ey
. Regional anesthesia : its technic and clinical application . clined upward and frontward. In case of alcohol injec-tion, the nerve must be located before injection is commenced. Pares-thesias in the upper jaw, or teeth, indicate that the nerve has been hit,in which case the anesthesia is almost immediate. For surgical pur-poses it is not necessary to make intraneural injections, since they areoccasionally followed by severe pain lasting several days and evenweeks. Injection into the sphenomaxillary fossa of large quantities of ^fluid are likely to be followed by exophthalmos, edema of the eyelids, 76 REGIONAL ANESTHESIA and at the same time anesthesia of the ophthahnic nerve, conditionswhich are not desirable. 2. By introducing the needle in the angle formed by the anteriorborder of the coronoid process of the ascending ramus of the mandiblewith the lower margin of the malar bone (Schlosser route) (Fig. 45).Needle No. 3 (8 cm.) is introduced transversely and directed a littleupward toward the tuberosity of the maxilla; after taking contact with. Fig. 46.—Maxillary block by the orbital route. The needle in the vertical positiontakes contact with the floor of the orbit before being shifted to the horizontal in thedirection of the arrow. the bone, it is withdrawn a little, so as to change its direction, andreintroduced slightly inclined backward until it is felt entering thesphenomaxillary fossa, immediately after losing contact of the maxilla,at about 5 or 6 cm. from the skin surface. The general direction ofthe needle is then upward, backward, and inward toward the apex ofthe orbit. If paresthesias are obtained in the territory of the spheno-palatine ganglion the injection is made without going any further BLOCKING OF CRANIAL NERVES 77 since the maxillary nerve lies close to it; 2 of the 2 per cent, solutionare then injected after making sure that the point of the needle doesnot lie in the lumen of the internal maxillary artery. Hematomas ofthe cheek are not
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