. Regional anesthesia : its technic and clinical application . Fig. 42.—The maxillary i and its branches. cavity through the sphenomaxillary fissure. It lies in the floor of theorbit in the infra-orbital groove and canal, and emerges through theinfra-orbital foramen, where it breaks up fanwise into three terminalgroups of branches (Fig. 42). Within the sphenomaxillary fossa themaxillary nerve gives off the sphenopalatine, the posterior and middlesuperior dental, and the temporomalar nerves; in the infra-orbital BLOCKING OF CRANIAL NERVES 73 groove, the middle (sometimes) and the anterior super
. Regional anesthesia : its technic and clinical application . Fig. 42.—The maxillary i and its branches. cavity through the sphenomaxillary fissure. It lies in the floor of theorbit in the infra-orbital groove and canal, and emerges through theinfra-orbital foramen, where it breaks up fanwise into three terminalgroups of branches (Fig. 42). Within the sphenomaxillary fossa themaxillary nerve gives off the sphenopalatine, the posterior and middlesuperior dental, and the temporomalar nerves; in the infra-orbital BLOCKING OF CRANIAL NERVES 73 groove, the middle (sometimes) and the anterior superior dental infra-orbital nerve gives off the inferior palpebral, lateral nasal,and superior labial branches. The maxillary nerve supplies the cheek, lower eyelid, side of thenose, upper lip, upper teeth, mucous membrane of the nose, naso-pharynx, antrum, posterior ethmoidal cells, soft palate, tonsils, androof of the Fig. 43.—Maxillary block by the extra-oral—zygomatic route (1). The maxillary nerve may be anesthetized at the foramen rotundumby the orbital route, as proposed by Matas, or in the sphenomaxillaryfossa by the lateral or zygomatic route, as described by Schlosser andothers. It may also be reached through the mouth either by passingthe needle laterally to the tuberosity of the maxilla, or behind the lastupper molar tooth. Two routes of approach are, therefore, available:the oral and the extra-oral. In dentistry, preference is given to the oralroute, while in general surgery this route is restricted to cases wherethe extra-oral route is rendered difficult owing to serious changes in the 74 REGIONAL ANESTHESIA anatomic features of the region. The sphenopalatine or Meckelsganglion lies just beneath the maxillary nerve, in the maxillary fossa,so that blocking the maxillary nerve means blocking the ganglion andits efferent branches, the palatine nerves. Extra-oral—Zygomatic Route.—Th
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