ON CIRCULAR OR END-TO-END SUTURING OF ARTERIES: BEING A MODIFICATION OF AN ALREADY PUBLISHED METHOD
E. A. Smith · BMJ · 1910
I407Vety rarely will injection of the supraorbital notch require an anaethetic.I have injected this nerve in eighteen patients altogether, seven of whom were cases of tic douloureux, and in only one was an anaesthetic necessary.This treatment of injection of the nerve trunks with strong alcohol is, I am absolutely convinced, a sure cure for the pain in tic douloureux; not a permanent cure as with excision of the Gasserian ganglion, but giving complete relief from the pain for periods varying from two to five months, when the injection has been only perineuritic, and has produced no anaesthesia, to twelve or eighteen months, or even longer, in the more successful cases in which the injection has properly punctured the nerve at the deep foramen, producing complete anaesthesia of the anatomical distribution of the nerve.When the pain returns, as it is likely to do ultimately, the same process can be repeated, giving generally a longer period of immunity from pain than on the first occasion, and so on apparently indefinitely.With the needles I use, no scar is produced which can be detected after the lapse of ten days to a fortnight, even though as many as three injections may have been7given -at about the same spot within a few days.With proper precautions and strict attention to asepsis, there is absolutely no risk to life, and the only troubles I have met with were in three patients, two of whom had slight transient diplopia, one partial diminution of the colour sense on the one side.and in one case a certain degree of Eastachian deafness.Slight haemato- mata may occasionally develop after an injection, especially after injection of the foramen ovale, or of the infaorbital foramon, causing a bruised appearance lasting for a few days.Swelling of the cheek or eyelid always follows a superficial injection of the infraorbital foramen or supraorbital notch, closing the eye in the latter case for a day or two, the swelling not entirely disappearing for fonr or five aave.Iniection of the foramen rotundam is said to cause sometimes considerable swelling of the lower eyelid and chemosis of the conjunctiva, but I have not met with this in my own practice.