. Regional anesthesia : its technic and clinical application . amen ovale is in most cases filled by the third branch in sucha way that, to reach the gasserian ganglion, the needle inevitablystrikes the nerve at the entrance of the canal and induces paresthesiasin its territory. The situation of the foramen ovale, at the base of the pterygoidprocess, varies with the skull; but the chief landmark is the smoothinfratemporal plane, which is anterior to the foramen and with whichthe needle must come in contact before it reaches the foramen ovale. Three superficial landmarks are ordinarily taken, s
. Regional anesthesia : its technic and clinical application . amen ovale is in most cases filled by the third branch in sucha way that, to reach the gasserian ganglion, the needle inevitablystrikes the nerve at the entrance of the canal and induces paresthesiasin its territory. The situation of the foramen ovale, at the base of the pterygoidprocess, varies with the skull; but the chief landmark is the smoothinfratemporal plane, which is anterior to the foramen and with whichthe needle must come in contact before it reaches the foramen ovale. Three superficial landmarks are ordinarily taken, so as to establishthe direction in which the needle should be introduced through thedeep structures, in order to reach the infratemporal plane: 56 REGIONAL ANESTHESIA (a) A point situated at the level of the second upper molar point is about 3 cm. lateral to and a little above the angle of themouth. (b) The pupil of the eye, on the same side. (c) The midpoint of the zygoma, on the same side. GasserLan. <;jUoOph-thaltnlc N ; ^^. •Inf. detx-tal Fig. 29.—a, Gasserian ganglion block by the Hartel route; b, superior maxillary blockby the Matas route. Besides these three points, which are meant only to guide the needletoward the infratemporal plane, a fourth point, the articular tubercleof the zygoma, serves to direct the needle into the foramen ovale. Technic.—The patient lies on his back and the operator stands on BLOCKING OF CRANIAL NERVES 59 the side to be injected. Both patient and operator face each an appHcator moistened with tincture of iodin, or with a steriledermographic pencil, the midpoint of the zygomatic arch and thearticular tubercle of the zygoma are traced on the skin. At about3 cm. lateral to and a little above the angle of the mouth a wheal israised, marking the level of the second upper molar tooth. The patient
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