The Laryngoscope Volume 29

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1919 Excerpt: ...and Frazier. I prefer the technic of Frazier, which has been published, and needs no detailed repetition. A few points should, however, be discussed. The great mortality of the earlier operations was due to attempts at removal of the ganglion itself, with its attendant hemorrhage, shock and sepsis. Much was gained when Spiller discovered that section of the sensory root of the ganglion gave complete and permanent relief from the neuralgia as Frazier has proven by cases remaining cured after a period of 15 years. Abbe also simplified the operation by contenting himself with the division of the second and third branches of the trifacial at the foramina of exit. This operation, strangely enough, maintains that since the neuralgia is practically always in these two divisions of the nerve it is not necessary to consider the ophthalmic nerve. Cushing and Frazier adopted certain proven points of safety in the methods of Spiller and Abbe, and then simplified the method of approach to the ganglion, all to the end that a low mortality is now the rule. The aim of the operator now is seldom to remove the Gasserian ganglion, and hence many of the unfortunate surgical possibilities of the former operation are obviated. The plan of section of the sensory root of the ganglion, as advocated by Spiller, and extensively practiced by Frazier is no doubt the best procedure. The intracranial operation of section of the sensory root, while requiring an extensive surgical training for its performance, and a clear knowledge of the structures dealt with, is but slightly more difficult than some radical mastoid operations, especially when the latter operation deals with labyrinth complications. When the dura has been sufficiently exposed by the method of Frazier the first difficulty ...