IX Extranasal Block Anesthesia for Submucous Resection of the Nasal Septum

Abstract

Prompt and thorough local anesthesia for submucous resection of the nasal septum in the majority of cases can be obtained by the time-tested method of applying cotton pledgets of cocaine and adrenalin to the mucous membrane of the nasal septum.Topical application of cocaine mud to the septal mucous membrane or novocain injections directly into the septum secure the same results. All of these methods of anesthesia are made inside the nasal cavity and have been highly satisfactory in most cases. There are, however, some noses where it is impossible to introduce any anesthetizing agent into the nostril because of a completely blocking anterior deviation of the septum which abuts up against, or is in actual contact with, the lateral wall of the nose. In rare cases the septum may be actually adherent to the lateral wall of the nose because of adhesions, the result of previous ungentle nasal treatments for sinusitis and allied conditions. Into such a nostril it is impossible to introduce a satisfactory local anesthetic. Such septums are often operated on under ether anesthesia because local anesthesia is inadequate and painful. It is for such cases that I propose a prompt acting and thoroughly efficient method of securing local anesthesia by means of an extranasal block 'injection of the nerves supplying the septal mucous membrane before they enter the nasal cavity, that is, by novocain injections made outside the nasal cavity.This method for securing local anesthesia is also applicable for high deviations of the septum made by the quadrangular cartilage and the perpendicular plate of the ethmoid bone, for septal spurs where it is impossible to apply topical anesthesia to the posterior surface of the spur, and for horizontally placed vomer ridges where the vomer is almost in contact with the floor of the nose. These devia-