Annals of surgery . ber suit is applied. Afterthe patient is under surgical anaesthesia he is placed in thehead-up incHned posture at an angle of 45°. (See Fig. i.)This posture will cause a striking blanching of the face andneck. The common carotid artery is closed temporarily withthe authors clamp and the rubber turban applied. We havenow been secured against serious haemorrhage from the scalp,brain and dura. The middle meningeal gives us no further 846 GEORGE CRILE. concern. It is a matter of no special consequence by whatroute we enter the skull so long as sufficient room is securedfor the
Annals of surgery . ber suit is applied. Afterthe patient is under surgical anaesthesia he is placed in thehead-up incHned posture at an angle of 45°. (See Fig. i.)This posture will cause a striking blanching of the face andneck. The common carotid artery is closed temporarily withthe authors clamp and the rubber turban applied. We havenow been secured against serious haemorrhage from the scalp,brain and dura. The middle meningeal gives us no further 846 GEORGE CRILE. concern. It is a matter of no special consequence by whatroute we enter the skull so long as sufficient room is securedfor the further technic. After the excision of the bone is com-pleted and the dura exposed, the remaining source of haemor-rhage is venous. Innumerable small, thin-walled veins areopened at every turn. The oozing, while not rapid, is underordinary circumstances just sufficient to constantly obscurethe branches and the body of the ganglion. The control ofthis haemorrhage, then, is the key to the entire situation. St i^U^ =0. Fig. 3.—Special instruments for use in removal of the Gasserian ganglion, aa, clamps fortemporary compression of the common carotid artery ; b, ring retractors for venous com-pression ; c c, blunt dissectors for elevating the ganglion. Such control has been very satisfactorily accomplishedby means of simple little retractors made of wire loops, inform like tongue retractors, the slender handles bent at rightangles. Three or four of these may be required. The pur-pose of these retractors is that of pressing the end of a roll ofsterilized gauze one inch wide, made of two layers folded in OPERATIONS UPON THE HEAD AND NECK. 847 SO as to control loose threads. By means of these small wire-ring retractors and the little rolls of gauze a pressure zonesurrounding the field in which the ganglion lies is causes a local circular anaemia and the instruments are notin the way of the operator. As fast as the operation is ad-vanced—, exposure and division
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
