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

  • William Walsham
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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    The results of the above cases, I think, speak for themselves, and require no further comment. I have given the briefest outline of them, for, as previously said, I intend publishing them in full when a longer time has elapsed. In the meantime, when last heard of, the patients had been relieved for periods of three years, fourteen months, thirteen months, six months, three months, and five months, and even should the neuralgia again return, these many months of respite should alone compensate for the few days’ confinement necessitated by the operation. A few words on the methods of stretching the inferior dental and auriculo-temporal nerve. The operations for stretching the supra- and infra-orbital are too well known to call for any remarks. The inferior dental has been exposed in various ways :1 (1) by division of the cheek, through its entire thickness, at a spot corresponding with the anterior edge of the ramus of the jaw, without dividing the mucous membrane; (2) by division of the cheek at a spot corresponding with the sigmoid notch ; (3) by division of the soft parts over the posterior border of the ramus of the jaw in a direction from behind and below, inwards and upwards; (4) by removal of a portion of the angle of the jaw; (5) by trephining the ramus after division of the soft parts just above the commencement of the inferior dental canal; (6) from within the mouth. The last method of exposure was the one used for stretching the nerve in the above cases, and although I worked it out in the dissecting room—not knowing that it had been already employed—I found, on looking up the subject, that it would appear to have been first resorted to by Paravicini. Its superiority over the other methods cannot, I venture to think, be questioned. No scar is left externally, and if the anatomy of the parts be borne in mind, the operation should not be attended with much, if any, difficulty. The mouth having been opened by a gag, an incision through the mucous membrane only is made from the last molar tooth in the upper jaw to the last molar tooth in the lower. The finger is now introduced into the wound and insinuated between the ascending ramus of the jaw and the internal pterygoid muscle. The small spur-like projection of bone at the entrance of the inferior dental canal is next felt for, and serves as a guide to the nerve. An aneurysm 1 Wiener medizinisclie Wochenschrift, March 31, 1874, and London Medical Record, 1874, p. 275.
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