. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. pass through from the cheek to the ganglion Gasseri. We had chosen our puncture point in the lateral region of thecheek, opposite the alveolar margin of the second upper molar point of the cannula penetrates the skin and finds itself in Bi-chats fat of the cheek. The finger, placed in the mouth of the pa-tient, feels the needle from the mucous membra
. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. pass through from the cheek to the ganglion Gasseri. We had chosen our puncture point in the lateral region of thecheek, opposite the alveolar margin of the second upper molar point of the cannula penetrates the skin and finds itself in Bi-chats fat of the cheek. The finger, placed in the mouth of the pa-tient, feels the needle from the mucous membrane, and accompaniesthe advancing point of the same through the first strait between themargin of the lower jaw and the tuber maxillare. The linger main- 59^ LOCAL ANESTHESIA tains the integrity of the mucous membrane of the vestibulum oris,this being accomplished by a curved motion of the needle around thebuccinator muscle. The needle, therefore, goes between (medially)the buccinator muscle on the one side, and the masseter muscle,lower jaw, with processus coronoideus and temporal muscle (laterally)on the other side, through into the fossa infratemporalis, and nowendeavors by perforation of the pterygoideus muscle externus, which. Fig. 221.—Lateral route to foramen rotundum. (Braun.) fills the entire fossa, to reach the planum infratemporale, in connec-tion with which, as we have seen above, finger-feeling can be auxiliaryonly in a portion of the cases. We need, therefore, other fixedpoints. Such a point is the depth. Before we stick the needle in wemark with the sliding catch a distance of 5 to 6 cm.; in case of forwardcurving of the cheek by a tumor, still more. We are thereby alwaysinformed as to the depth reached, and can thus protect ourselvesfrom gross errors. In the second place we must now consider adirection discernible on inspection of the whole skull*, and we have THE HEAD, SCALP, CRANIUM, BRAIN, AND FACE 593 been able by careful observation and many examinations t
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