. 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. 222 isseen the angle and point of crossing within the skull of the axes of theneedle if continued backward in bilateral puncture. The observance of the rule given above for the direction, as well asnaturally the bone-feeling on the planum infratemporale, protects uscertainly from this error. The pterygoid muscle is perforated near THE HEAD, SCALP, CRANIUM,
. 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. 222 isseen the angle and point of crossing within the skull of the axes of theneedle if continued backward in bilateral puncture. The observance of the rule given above for the direction, as well asnaturally the bone-feeling on the planum infratemporale, protects uscertainly from this error. The pterygoid muscle is perforated near THE HEAD, SCALP, CRANIUM, BRAIN, AND FACE 551 its origin on the pterygoid process and tuber maxillare; often the can-nula goes through between the two heads of origin. Before we conduct the point of the needle from the fossa infra-temporalis into the foramen ovale, we take the precaution of slippingback the sliding catch of the cannula 15 cm. from the skin-punctureplace, in order thus to be aware of the depth of the further advance. A summary of the essential points in making the Hartel punctureis given by Hartel as follows: (a) Puncture in the cheek at the height of the alveolar margin ofthe second upper molar tooth, establishing first on the cheek a wide. Fig. 218—Pterygopalatine fossa and contents, showing the S form of the maxillarynerve and the position of the terminal branches of the internal maxillary artery beneath thenerve: i, Zygomatic nerve; 2, infra-orbital artery; 3, int. maxillary artery; 4, mandibularnerve; 5 maxillary nerve; 6, sphenopalatine ganglion; 7, ophthalmic nerve; 8, int. carotidart.; 9, gasserian ganglion. (After Testut and Jacob.) area of cutaneous anesthesia, which allows a variation of the puncturepoint toward the front or back according to the principle of the con-centric puncture. (b) The cannula for puncture must be mm. thin, 10 cm. long,and be provided with a flatly ground point. Before the puncture withthe puncture-cannula. the anticipated puncture depth to the p
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanesthe, bookyear1914
