. Regional anesthesia : its technic and clinical application . the lower borderof the zygoma, through the sigmoid notch, at the midpoint of thezygomatic arch (Schlosser). Needle No. 3 (8 cm.) is introduceddeeply in a transverse direction, a little upward, toward the pterygoidprocess, and the depth at which the needle takes contact with thisbone is recorded by a small piece of rubber or cork previously threadedon the needle (Braun). The needle is then withdrawn until its pointreaches the subcutaneous tissue, so as to change its direction, and is BLOCKING or CR.\NIAL NERVES 75 reintroduced incli
. Regional anesthesia : its technic and clinical application . the lower borderof the zygoma, through the sigmoid notch, at the midpoint of thezygomatic arch (Schlosser). Needle No. 3 (8 cm.) is introduceddeeply in a transverse direction, a little upward, toward the pterygoidprocess, and the depth at which the needle takes contact with thisbone is recorded by a small piece of rubber or cork previously threadedon the needle (Braun). The needle is then withdrawn until its pointreaches the subcutaneous tissue, so as to change its direction, and is BLOCKING or CR.\NIAL NERVES 75 reintroduced inclined a little frontward toward the sphenomaxillaryfossa (Fig. 44). When the recorder reaches the skin surface it marksthe depth at which the point of the needle had struck the pterygoidprocess. If no bony contact is now obtained, the needle is introducedvery slowly cm. further and injection of 2 of the 2 per cent,novocain solution made at that point. If the needle again strikes thebone, it should be partially withdrawn and reintroduced in a direction. Fig. 45.—Maxillar> block by the extra-oral—zygomatic route (2). a little more inclined upward and frontward. In case of alcohol injec-tion, the nerve must be located before injection is commenced. Pares-thesias in the upper jaw, or teeth, indicate that the nerve has been hit,in which case the anesthesia is almost immediate. For surgical pur-poses it is not necessary to make intraneural injections, since they areoccasionally followed by severe pain lasting several days and evenweeks. Injection into the sphenomaxillary fossa of large quantities of ^fluid are likely to be followed by exophthalmos, edema of the eyelids, 76 REGIONAL ANESTHESIA and at the same time anesthesia of the ophthahnic nerve, conditionswhich are not desirable. 2. By introducing the needle in the angle formed by the anteriorborder of the coronoid process of the ascending ramus of the mandiblewith the lower margin of the malar bone (Schlosser route)
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