. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. alfissure. In the living subject the most important guide for our punc-ture is the subjective statement of the patient regarding radiatingpain in the region of the second branch of the trigeminus. (See TableI) 5io LOCAL ANESTHESIA The axial injection of the foramen rotundum, the Matas routethrough the orbit and sphenomaxillary fissure, has been erroneously
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. alfissure. In the living subject the most important guide for our punc-ture is the subjective statement of the patient regarding radiatingpain in the region of the second branch of the trigeminus. (See TableI) 5io LOCAL ANESTHESIA The axial injection of the foramen rotundum, the Matas routethrough the orbit and sphenomaxillary fissure, has been erroneouslycredited by Braun, Hartel, and others to Payr; this, however, is anerror, as the conception of this method of approach and its first ap-plication undoubtedly belong to Prof. Matas, who first used it in 1898,and it was published by him in his report on Local and RegionalAnesthesia, etc., to the Louisiana State Med. Soc, April, from this report are given later on. This successful application stimulated other efforts in this direc-tion, and much of the work which appeared in the few years followingalong these lines undoubtedly received the idea and stimulus from thisprocedure. Anterior and posterior ethmoidal foraminaI !. Fig. 176.—Median and lateral orbital injections. (Braun.) In studying the orbit, with a view of the application of the variousmethods, we see that the foramen rotundum is concealed from viewjust below the floor of the orbit, and that if this plane were used as ameans of reaching it the needle, if directed toward the apex of theorbit medially along the floor, would pass into the superior orbitalfissure, and meeting no bony resistance here may, if advanced too far,pass backward into the cranial cavity. This route, however, is dis-cussed by Hartel (Fig. 179). This would seem a more dangerous route, and not likely to lead tothe foramen rotundum, but above it. The original route, as advocated by Prof. Matas, traverses the orbitfor but a short distanc
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