. Regional anesthesia : its technic and clinical application . epharynx. (6) The internal laryngeal branch passes downward and inwardbetween the middle and inferior constrictors of the pharjTix and entersthe lajTux by piercing the thyrohyoid membrane. It supplies themucous membrane of the base of the tongue, epiglottis, and larynx. The superior laryngeal nerve is therefore accessible between the greatcomu of the hyoid bone and the superior comu of the thyroid cartilage. Technic.—The patient may be in the sitting erect position, facingthe operator, or in the recumbent dorsal position, with the
. Regional anesthesia : its technic and clinical application . epharynx. (6) The internal laryngeal branch passes downward and inwardbetween the middle and inferior constrictors of the pharjTix and entersthe lajTux by piercing the thyrohyoid membrane. It supplies themucous membrane of the base of the tongue, epiglottis, and larynx. The superior laryngeal nerve is therefore accessible between the greatcomu of the hyoid bone and the superior comu of the thyroid cartilage. Technic.—The patient may be in the sitting erect position, facingthe operator, or in the recumbent dorsal position, with the head tilted a BLOCKING OF CRANIAL NERVES 3 little backward, so as to stretch moderately the soft structures of theanterior aspect of the neck. The great cornu on the side to be injectedis rendered prominent by pressing with the left forefinger on the greatcomu on the opposite side (Fig. 86). Needle No. 2 (5 cm.), imattachedto the syringe, is introduced through a wheal raised 1 cm. below and2 cm. in front of the extremity of the prominent cornu and advanced. Fig. 86.—Superior laryngeal block. The needle is inserted at a point 1 cm. below and2 cm. in front of the extremity of the great cornu of the hyoid bone. backward and slightly upward toward the cornu. The needle passesbetween the thyrohyoid muscle and the thyrohyoid membrane, and thenerve is gently sought for between the cornua of the hyoid bone andthyroid cartilage. The point of the needle must not be allowed to gobeyond the line joining these cornua, which is the region of the blood-vessels. After making sure that no blood-vessel has been punctured, the REGIONAL ANESTHESIA syringe is connected with the needle and injection made of 2 of the2 per cent, solution. If paresthesias are induced, radiating toward theear, the injection is made without moving. In the absence of paresthesiashalf of the solution is injected below the comu of the hyoid bone andthe rest distributed while the needle is being withdrawn. During th
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