Neurotomy of the superior maxillary branch of the trigeminus : including neurectomy of the spheno-palatine ganglion for the relief of tic-douloureux / by Frederic S. Dennis.

  • Dennis, Frederic S. (Frederic Shepard), 1850-1934.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Neurotomy of the superior maxillary branch of the trigeminus : including neurectomy of the spheno-palatine ganglion for the relief of tic-douloureux / by Frederic S. Dennis. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    I then with a trephine carefully removed the anterior wall of the antrum of Highmore, leaving the inferior orbital foramen intact, with the branches of the nerve reflected upon the supe- rior flap. I then with a smaller trephine removed a disk of bone from the posterior wall of the antrum, which exposed the spheno-maxillary fossa. There had been but little haemorrhage during the operation until then, when there was a welling up of blood from the spheno-maxillary fossa. A sponge attached to a holder was introduced, and pressure made for a few moments, when the bleeding ceased. I then commenced to break up the inferior wall of the infra-orbital canal beginning at the inferior por- tion of the intra-orbital foramen, being careful not to injure the nerve. This I did with a small chisel and a strong pair of scissors. I then dropped the nerve into the antrum and traced it without any difficulty through the spheno-maxillary fossa, to the distal end of the foramen rotundum where the nerve makes its exit into the spheno-maxillary fossa. I then with a pair of long curved scissors divided the nerve at a point where it made its exit from the foramen rotundum into the spheno-maxillary fossa. I then broke up Meckel’s gan- glion, which lies at the inner aspect of this nerve at this point. After waiting a short time, there being no haemorrhage, the integuments were brought together with interrupted silver su- tures and adhesive strips, after thoroughly bathing the parts with carbolized water. There was a tent introduced at the lower angle of the perpendicular incision, to permit the dis- charge of blood or pus which might occur, then a compress of carbolized jute was placed over the wound and retained by adhesive strips. The patient came readily from under the in- fluence of the ether. I remained with him for about an hour after the operation, during which time he did not suffer any pain. Having been in the habit of taking morphine for a long while, I ordered a grain of morphine to be given at bed- time. I found him the next day free from pain, having passed as he expressed it a “ heavenly ” night. His pulse was 90, skin hot and dry, temperature 100°. I ordered spirits of mindere- rus, an ounce once in two or three hours. In the evening his pulse was 88, temperature 99°, and I ordered one grain of