. Manual of operative surgery. peration. (Braunand Lossens Modification of LuckesOperation.)—Step 1.—Expose the infra-orbital nerve at its exit from the bone. Step 2.—Beginning at a point just be-hind and below the external angular proc-ess of the frontal bone, make an incisionbackwards and downwards to near thetragus. From the same starting-pointmake another incision downwards andforwards to the lower margin of thezygoma. Reflect downwards the triangu-lar flap of skin and subcutaneous tissuethus outlined. With a finger saw, chisel,or Gigli wire saw divide the zygoma infront and behind. Rose r
. Manual of operative surgery. peration. (Braunand Lossens Modification of LuckesOperation.)—Step 1.—Expose the infra-orbital nerve at its exit from the bone. Step 2.—Beginning at a point just be-hind and below the external angular proc-ess of the frontal bone, make an incisionbackwards and downwards to near thetragus. From the same starting-pointmake another incision downwards andforwards to the lower margin of thezygoma. Reflect downwards the triangu-lar flap of skin and subcutaneous tissuethus outlined. With a finger saw, chisel,or Gigli wire saw divide the zygoma infront and behind. Rose recommends that before the zygoma is divided holesbe bored on each side of the line of section so that everything may be readyfor wiring the fragments in position on the completion of the active part ofthe operation. Separate the temporal fascia from the upper edge of the zygomaand turn the bone downwards. Retract the tendon of the temporal mus-cle backwards. The pterygo-maxillary fossa is exposed, with its fat and plexus. Fig. ;2.—Excision superior maxillarynerve. {Farabeuf.) NEURECTOMY TIC 69 of veins. If one now pushes the fat back with a blunt retractor, one at thesame time keeps the venous plexus and internal maxillary artery out of theway. Demonstrate the posterior orbital fissure with a probe or strabismushook and distinguish the superior maxillary nerve and its accompanyingvessel (Fig. 52). The course of the nerve from its exit from the skull is down-wards, forwards and outwards. The artery runs inwards, forwards andupwards. Step 3.—Tie a ligature round the nerve for the purpose of traction. Dividethe central end of the nerve as close to the foramen rotundum as traction and torsion pull the peripheral end of the nerve out of its bonycanal. By this operation the whole trunk of the nerve is excised from theforamen, rotundum to the cheek. Step 4.—Attend to hemostasis. Replace the zygoma and fix it in positionby wire or chromicized catgut sutures. Pro
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