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288 OPERATIVE DENTISTRY

to the production of an agent like novocain which is comparatively
safe for general practice. Regional anesthesia is by no means
limited to the field of dentistry, but its use is as broad as the field
of surgery on mankind, as vrell as that on the lower animals. The
surgeon has but to know his anatomy to be able to render a region
as void of sensation as though the part had been amputated from
the body. For instance, the arm is now operated on without pain,
even to amputation, by surrounding the axillary nerve with a
puddle of a two per cent solution of novocain with suprar6nin,
reached with a needle in the top of the shoulder posterior to the
clavical and internal and anterior to the scapula. Aside from the
completeness of the anesthesia obtained, regional anesthesia has
to recommend it the fact that the injection is made far from the
field of operation, which is many times undergoing pathological
changes often due to bacterial invasion. About the face, we have
seven separate and distinct nerve blocking operations for regional
anesthesia. The injections are ; Gasserian ganglion, Spheno-maxil-
lary, Pterygo-mandibular, Mental, Infra-orbital, Zygomatic, and
Posterior and Anterior palatine.
The Gasserian and Spheno-maxillary Injections are employed for
major surgical operations about the face and will be passed over
by simply mentioning them, as the strictly operative dentist will
have no need to employ them. However, the remaining five injec-
tions are of vital interest to the general practitioner of dentistry
and will be taken up in the order given.
Pteryg-o-Mandibular Injection has for its object the blocking of
the nerve supply to the lateral half of the mandible and the im-
mediate overlying tissues.
Technic of Injection. Palpate the posterior molar triangle hav-
ing first sterilized the immediate field of puncture with campho-
phenique. Then find the internal oblique line. Puncture the tis-
sues over its inner edge, using a forty-five millimeter iridio-platinum
needle, one centimeter above the plane of the inferior teeth with
the barrel of the syringe resting on the occlusal surfaces of the
bicuspids of the opposite side, as shown in Fig. 147. Push the
needle point four or five millimeters into the tissues. Now swing
the syringe to the position shown in Fig. 148 for the lingual nerve.
Again swing the syringe into the position shown in Fig. 149. Push
the needle into the tissues, closely following the inner surface of
ramus for a distance of about two centimeters in all (see Fig. 150),
varying with the size and age of the patient. To folloAv the inner