A manual of operative surgery . ioris is exposed, and must be severed in the lineof the original nerve is nowreached, and can bedealt with. The partsare vascular, and theview of the nerve isapt to be occludedby free bleeding. Comment.—Sectionof the nerve at thisspot cuts off merelythe terminal branches,to the face. In order to reach,the superior maxillarynerve where it gives,off the branches to^the palate, teeth, andupper jaw, various,procedures have beendevised for obtainingaccess to the pterygo-maxillary fossa, theso-called operations is A, B, Portion of the nerve to be excised ; C
A manual of operative surgery . ioris is exposed, and must be severed in the lineof the original nerve is nowreached, and can bedealt with. The partsare vascular, and theview of the nerve isapt to be occludedby free bleeding. Comment.—Sectionof the nerve at thisspot cuts off merelythe terminal branches,to the face. In order to reach,the superior maxillarynerve where it gives,off the branches to^the palate, teeth, andupper jaw, various,procedures have beendevised for obtainingaccess to the pterygo-maxillary fossa, theso-called operations is A, B, Portion of the nerve to be excised ; C, n, Wall of on Meckels ganglion -cm, Ophthalmic division; c, Gasserian They are SQ difficult and so disappointingthat we omit their description in favour of an operation whichreaches the superior maxillary nerve before it has given off any-branches at all. Intracranial Resection of the Superior Maxillary Nerve.—This should be reserved for cases of severe neuralgia involving,the distribution of the superior maxillary FIG. 228. -INTRACRANIAL RESECTION OF THE SUPERIORMAXILLARY NERVE. temporal fossaganglion. CHAP. Ill] TRIFACIAL NERVE 91 The method of approaching the nerve is exactly the same as forthe Gasserian ganglion (see pages 79 et seq.), by trephining the floorof the temporal fossa, elevating the dura mater, etc. The operator,however, aims at the front part of the middle cerebral fossa, finds thenerve at the foramen rotundum and traces it back to the will probably be unnecessary to ligature the middle meningeal artery,as the dura mater can be sufficiently raised without this. The nerve,being isolated, is very carefully cutthrough at the foramen rotundum,the divided end drawn outwards withfine forceps, and again divided closeto the ganglion. In this way fromone-third to half an inch can be re-sected. The procedure is certainlybetter ( more thorough) than neu-rectomy performed from the face, butwhether it will retain a place insurgery is doubtful.
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