. 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. e Needle.—After insertion the needle is advanced 524 LOCAL ANESTHESIA to the bone without entering the peritoneum (Figs. 187, 188). Acertain touch is soon acquired as to whether the needle is being ad-vanced in the correct direction, not too far pharyngeally, yet closelyenough to the bone. If, in case of a very sharp angle of the bone, theperiosteum is fou
. 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. e Needle.—After insertion the needle is advanced 524 LOCAL ANESTHESIA to the bone without entering the peritoneum (Figs. 187, 188). Acertain touch is soon acquired as to whether the needle is being ad-vanced in the correct direction, not too far pharyngeally, yet closelyenough to the bone. If, in case of a very sharp angle of the bone, theperiosteum is found to offer resistance, even though moderately, theneedle should not be advanced any farther, and under no conditionuse force, else the needle bores into the periosteum of the bone and issure to break. It is best to carefully withdraw the needle for a shortdistance, and, after slightly altering its direction pharyngeally, to ad-vance again posteriorly. The bone should not be reached before the needle has gone for acertain distance from the point of introduction (Figs. 184, 187, 188),yet not immediately at the internal oblique line, as has already beendemonstrated. External pterygoid m. Temporal m. — Genioglossus m.—Geniohyoid I. Internal pterygoid m. Digastric m. Mylohyoid m. Fif*. 100.—Origins and insertions of muscles upon inner surface of mandible. (Rauben and Kopsch.) Injection of Solution.—The solution should be emptied slowlyand carefully, beginning immediately upon insertion of the needle inorder to anesthetize simultaneously the Ungual nerve (should this bedesired—Author), which descends in front of the inferior dental nerve(Fig. 188). The bulk of the solution, however, is deposited at theoblique foramen. Penetration of the muscles in this region is out ofthe question, as has been shown above (Fig. 190). Neither is there any danger of puncturing the artery, which pos-sesses thick walls, is protected by the lingula, and has enough space toevade into the loose
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