. 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. Fig. 215.—Nerves of the head (from Arnold) seen from the side: a, Needle directedalong orbital route (Matas) into foramen rotundum; b, Hartel route to gasserian gang-lion. (Hartel.) 588 LOCAL ANESTHESIA then we find that it traverses the fossa infratemporalis, and passeson exactly in the middle line between the ascending branch of thelower jaw and the tuber ma
. 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. Fig. 215.—Nerves of the head (from Arnold) seen from the side: a, Needle directedalong orbital route (Matas) into foramen rotundum; b, Hartel route to gasserian gang-lion. (Hartel.) 588 LOCAL ANESTHESIA then we find that it traverses the fossa infratemporalis, and passeson exactly in the middle line between the ascending branch of thelower jaw and the tuber maxillare. For choosing the puncture jointit is important to know where the lateral projection of this axis on theupper jaw cuts the alveolar margin. This point is dependent on twodifferent factors, namely: (i) On the more or less steep course of theaxis of the trigeminus; (2) on the situation of the upper jaw. According to Fig. 207, the steeper the axis is the farther behindthe upper jaw it strikes; on the other hand, according to Fig. 208, an. Fig. 216.—Right pterygopalatine fossa, foramen rotundum and superior orbita!fissure seen from behind. Needle a is passed from the pterygopalatine fossa out of theforamen rotundum. Needle b is pushed in a steeper direction through the inferiororbital fissure and impinges within the superior fissure. (Hartel.) axis with equally steep course will reach a more or less high builtupper jaw farther forward or behind, and so appear more level orsteeper. Whatever the real basis of this relation may be in the in-dividual case, in practice both amount to the same thing; namely,that we may not seek the puncture point in an exactly designatedplace, for example, at the height of a certain molar tooth, but thatthe puncture point varies within certain limits. We may not expectthat we may penetrate forthwith into the skull by any one puncturepoint selected and reach our mark, but we must frequently makeup our minds to repeated ])uncture. This changes
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