A manual of operative surgery . rve by stating that he hadnot once known a permanent cure result from them. It is farotherwise with the operation of excision of the Gasserianganglion by the intracranial route, the Hartley-Krause the introduction of this the peripheral operations havepassed more and more into the background. It is true that 74 chap, in] NEURALGIA OF THE FIFTH NERVE 75 they are less severe proceedings, but the deformity left by themhas often been greater than that following the intracranialoperation. In fact, if carefully performed, the latter involveslittle or no d
A manual of operative surgery . rve by stating that he hadnot once known a permanent cure result from them. It is farotherwise with the operation of excision of the Gasserianganglion by the intracranial route, the Hartley-Krause the introduction of this the peripheral operations havepassed more and more into the background. It is true that 74 chap, in] NEURALGIA OF THE FIFTH NERVE 75 they are less severe proceedings, but the deformity left by themhas often been greater than that following the intracranialoperation. In fact, if carefully performed, the latter involveslittle or no disfigurement. It would, however, be incorrect to say that peripheral opera-tions on the branches of the fifth nerve have been wholly aban-doned. Now and then, the neuralgia being strictly limited toone branch, the patient may prefer the relief afforded, temporarythough it may be, to the major operation. We shall therefore first describe the operations on the Gasserianganglion, and subsequently treat briefly the various forms of. FIG. 220. — INCISIONS EMPLOYED IN THE REMOVAL OF THE GASSERIAN GANGLION, The left-hand incision is that employed in the early operations by the pterygoid route ; thescar causes much disfigurement, being situated wholly on the face. The right-hand oneis placed above the zygoma, the scar being concealed by the scalp. peripheral neurectomy. Stretching the branches of the fifthnerve is useless, and should never be performed. Exposureof the nerve-branch or nerve-trunk most concerned in the neuralgiaand injection into it of solution of osmic acid or strong alcoholhas been repeatedly tried, and the latter method has come intoconsiderable vogue on the Continent. The injection of alcoholcauses an inflammatory degeneration of the nerve, and maythus relieve the neuralgia, but it is an uncertain method, andis open to the objection that, like all forms of peripheral operation,there is little chance of permanent cure. The best results ofthe alcohol method (Schlosse
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