On the treatment of so-called epileptiform neuralgia, or the so-called incurable facial tic / by W.J. Walsham.

  • Walsham, William Johnson, 1847-1903.
Date:
[between 1880 and 1889?]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of so-called epileptiform neuralgia, or the so-called incurable facial tic / by W.J. Walsham. 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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    needle with a very short curve is now passed and hooked round the nerve, which can be then drawn visibly into the entrance of the wound. There are no important structures with the excep- tion of the inferior dental artery and gustatory nerve in the near neighbourhood. The latter is best avoided by remembering that whilst the inferior dental nerve passes into the bone the gustatory continues its course between the bone and the muscle, and is anterior and a little internal in its relative position to the inferior dental. Should the artery he wounded it will probably be torn rather than cut, and therefore not likely to bleed; were it to do so it is doubtful whether it could be tied, as the wound is deep and will barely admit the finger. There was no haemorrhage in any of the above-related cases, but had there been I should have endeavoured to staunch it by plugging. The internal lateral ligament which is inserted into the spur- like process of bone, follows somewhat the same course as the nerve, and may readily be mistaken for it. To avoid it the point of the aneurism needle should be made to hitch in the entrance of the canal, and thence swept upwards, backwards, and outwards around the nerve, keeping the point close to the bone. As the parts can hardly be seen the sense of touch must be trusted to as our guide. The wound, if the operation is neatly done, is small, and heals kindly and in a few days. I am not aware that the auriculo-temporal nerve has been hitherto stretched ; but I have found a case recorded by Dr. McGraw,1 in which the nerve was divided. The best guide to the nerve is the temporal artery. An incision about an inch long should be made parallel and immediately posterior to the artery, beginning just above the zygoma. Having carefully exposed the artery the nerve will be discovered just below and posterior to it. The nerve being of small size the dissection must be done neatly, or it will not be found. Meckel’s ganglion I removed by the operation which is known as Carnochan’s. A description of this operation will be found in the Proceedings of the Royal Mcdico-Chirurgical Society (vol. i. No. 5, New Series) by Mr. Chavasse, and in the discussion that followed his paper an account of some modifications which I sug- gested might be desirable to make in its performance. 1 Detroit Medical, Journal, November, 1877.