. Les rapports médicaux et chirurgicaux. Dissection postérieure par l'borderof la glande parotide a été amené à voir, soulevée et pushedforward, et dans l'étroit espace entre l'apophyse mastoïde et theramus de la mâchoire le nerf facial a été exposé où il entersthe glande. Le nerf était dur et gris au lieu de blanc comme softand est d'habitude. Le nerf est maintenant effacée Retour à * W. W. Grant : Journal American Medical Association, le 22 octobre 1910, Vol. LV.,p. 1438. La paralysie faciale traumatique. 191 où il stylomastoid les questions du foramen et notcut mais fut retenu par une boucle de soie. La moelle accessoire n'a fo

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. Medical and surgical reports. By blunt dissection the posterior borderof the parotid gland was brought to view, lifted and pushedforward, and in the narrow space between the mastoid and theramus of the jaw the facial nerve was exposed where it entersthe gland. The nerve was hard and gray instead of softand white as is usual. The nerve was now cleared back to * W. W. Grant: Journal American Medical Association, October 22, 1910, Vol. LV., p. 1438. TRAUMATIC FACIAL PARALYSIS. 191 where it issues from the stylomastoid foramen and was notcut but held up by a silk loop. The spinal accessory was found posterior to the sternomas-toid and followed down to where it enters that muscle justbelow a line from the lower edge of the maxilla. A loop wasput round this nerve. The next procedure was to expose thehypoglossal nerve. To do this the posterior belly of the digas-tric muscle was cut at about its middle and the ends turnedaside. Under the muscle lies the hypoglossal nerve resting PfOXlMAU EMCi OFSPINAL AceEssoFWTo FACKL. CUT BELLY btScfeMbENS HYPo-G-LOSS) To bVSTALENb SPINAL ACCES-SORY sTEf^^lo-M^STonb, TvJRN£b BACK Fig. L—Diagram of spino-facial anastomosis and descendens-spinal compensation. upon the hypoglossus muscle. Underneath the point wherethe digastric was divided was found the descendens hypoglossibranching from the hypoglossal. This descending branch wasdissected free down along the carotid sheath for about one inchand then held up by a loop. The facial nerve; was now cut at the stylomastoid foramenand the distal stump pulled outwards. The eleventh nervewas next cut about one-fourth inch from its point of entryinto the muscle and its proximal stump was united to the 192 TRAUMATIC FACIAL PARALYSIS. distal stump of the facial by three finest Pagenstecher stitches, the first one going through and through the nerves to givestrength to the union, the other two through neurilemma ofboth nerves but in a plane at right angles to that of the firststitch. The dissectio

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