. 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. e. into foramen(Hartel.) quirement of adherence to the so-called axis of the trigeminus; thatis, a straight Hne going from the middle of the impressio trigeminiot the petrous portion of the temporal bone through the middle ofthe foramen ovale (Figs. 204, 205). Only a cannula introduced intothe skull in this direction avoids collateral injuries of the tissues a
. 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. e. into foramen(Hartel.) quirement of adherence to the so-called axis of the trigeminus; thatis, a straight Hne going from the middle of the impressio trigeminiot the petrous portion of the temporal bone through the middle ofthe foramen ovale (Figs. 204, 205). Only a cannula introduced intothe skull in this direction avoids collateral injuries of the tissues adja-cent to the cavum MeckeH (Figs. 212, 213), namely, of the sinuscavernosus, of the carotis interna, of the sinus petrosus superior, andof the brain. If, as we have said above, the foramen ovale is not asimple hole, but forms a bone-canal about i cm. long, so we find nowthat the long axis of this canal corresponds to this axis of the trigemi-nus; in other words, passes parallel to the anterior surface of thepyramid of the petrous portion of the temporal bone (Fig. 206); if 582 LOCAL ANESTHESIA it should not do this, and, for example, should pass more steeply(Fig. 206, h), then the cannula would penetrate, not into the ganglion,. Fig. 206.—Schematic representation of the trigeminal axis and the direction theneedle should take to the gasserian ganglion: a, Normal type. The long axis of the bonycanal of the foramen ovale and the inclination of the petrous bone lie in the direction A,B; b, occasional variation. The long axis of the bony canal of the foramen ovale A, Bstands more steeply than the inclination of the petrosa C, D. (Hartel.) but through the dura into the temporal lobe; if it passes more on alevel, then the danger exists that the cannula from above, through
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