ALCOHOLIZATION — administration of alcohol in fabric with the purpose to cause a break of conductivity of nerves or development of sclerous process.
And. nerves Schlesser offered (C. Schlösser, 1903). V. I. Razumovsky (1909) for the first time applied And. a gasserova of a node for treatment of an epileptiform neuralgia, And. the cortical centers at epilepsy and an athetosis, And, branches of the wandering and sympathetic nerves in the field of an omentulum at gastralgias and a peptic ulcer. And. it is based on coagulating action on fabric of strong solutions of alcohol. Administration of alcohol in living tissues causes an aseptic necrosis with the subsequent rapid development of cicatricial fabric. Death of nervous tissue leads to chemical denervation of this or that area.
And. was widely adopted especially in neurosurgery: And. branches of a trifacial at neuralgia, a facial nerve for treatment of hyperkinesias of the person, motor nerves at spastic paraplegiya (Littl's disease), intercostal nerves at neuralgia and fractures of edges, a sciatic nerve at a sciatica. And. it is applied also at treatment of kauzalgiya and stump neuralgias. At treatment of obliterating diseases of arteries of extremities sometimes apply alcohol - novocainic blockade of the second — the third chest or the second — the fourth lumbar sympathetic nodes. And. causes final or partial fracture of structure of nodes and switching off of their functions that favorably affects the course of a disease. Offer also And. periarterial neuroplexes by wetting of an outer surface of arteries alcohol or periarterial injections of alcohol (N. of N, Nazarov, P. I. Stradyi).
And. a medulla of an adrenal gland it is applied for the purpose of a demedullyation or as addition of a resection of an adrenal gland at an obliterating endarteritis.
And. star-shaped and cervical sympathetic nodes it was applied to treatment of stenocardia; And. a phrenic nerve — for creation of temporary paresis of a diaphragm at a pulmonary tuberculosis.
Dolyotti (A. M. of Dogliotti, 1931) offered administration of alcohol to the spinal canal to patients with nonresectable malignant tumors of a bladder, prostate, rectum for blockade of sensitive roots for the purpose of removal of pains.
Some surgeons apply And. for treatment of hemorrhoids and a prolapse of the rectum. 70% enter alcohol into a pararectal fat at the rate of 1,5 ml on 1 kg of body weight; total quantity of the alcohol entered to children shall not exceed 20 — 25 ml. And. hemorrhoidal nodes leads to their sklerozirovaniye and a zapustevaniye.
And. it is applied also to treatment of hemangiomas, lymphangiomas, to removal of a pain syndrome at styloidites, an epicondylitis, a mastodynia, a coccyalgia and at some other diseases.
And. usually produce by endoneural introduction by the syringe 80% of alcohol after preliminary anesthesia of 1 — 2% solution of novocaine or apply spirit of novocaine: Novocaini — 0,5; Spiritus Vini rectificati of 80% — 25,0 (sterilis).
Main complication And. it is caused by a possibility of necrotizing effect of alcohol on surrounding fabrics and bodies (a wall of a blood vessel, a wall of hollow body, etc.). Exact observance of the equipment A., introduction of the minimum quantities of alcohol allow to prevent this complication.
Alcoholization at an epileptiform neuralgia — administration of alcohol in peripheral branches of a nerve for the purpose of «chemical section» — leads to a break of conductivity and, therefore, to the termination of painful attacks. Method A. peripheral branches almost forced out so-called deep And. (a gasserova of a node, or nervous branches at a base of skull). And. peripheral branches seldom gives complications, does not demand hospitalization of the patient, has no contraindications and it can be repeated at a recurrence.
For reduction of morbidity at the moment And. apply spirit of novocaine. A preliminary injection of solution of novocaine just before And. deprives of the doctor of an opportunity to be convinced of the correctness made And. The termination of pains is reached by administration of alcohol endonevralno, except for buccal and upper back alveolar nerves where it becomes perinevralno.
Hit of a needle in the corresponding nerve is determined by feeling by the patient of sharp pain, only after that slowly enter alcohol under small pressure, rotating a needle around an axis. Come the ambassador A. the resistant anesthesia of all area innervated by the corresponding nerve is the main indicator correctly made And. In certain cases ambassador A. pains can remain the first 6 — 12 days. Hot-water bottles, compresses and physiotherapeutic procedures for the purpose of acceleration of a rassasyvaniye of a swelling, the inevitable ambassador A. Prodolzhitelnost of the painless period ambassador A are categorically contraindicated. from 6 months to 6 years.
At neuralgia of two branches the injection of alcohol is done in originally struck branch since pains in the field of other branch are often caused by irradiation.
At neuralgia of the I branch make And. supraorbital nerve. The cutting of the same name, is more rare an opening, is easily probed. In order to avoid emergence of a painful attack it is recommended to make a palpation on the healthy party since these reference points are usually symmetrized on both parties. Having taken big and index fingers a superciliary arch in the place of a projection of an opening or cutting, do in a stake (fig. 1) to a bone and the easy movements of a needle in a radius of 0,5 cm find a nerve. Without changing the provision of a needle, enter solution before complete cessation of pains, but no more than 0,5 — 0,75 ml. In 1 — 2 min. there has to occur total loss of sensitivity in the field of an innervation of the I branch. Next day the okologlazny area swells up a little and the palpebral fissure is closed. Within 4 — 5 days these phenomena disappear.
At neuralgia of the II branch make And. infraorbital, front palatal, upper back alveolar and zygomaticofacial nerves depending on localization of «a kurkovy zone», i.e. the limited site of skin or a mucous membrane, the slight irritation to-rogo causes an attack. In most cases pains stop the ambassador A. one infraorbital nerve.
And. infraorbital nerve do in the channel of the same name or in the place of its exit of foramen infraorbitale (fig. 2 — 3). The infraorbital foramen is located on crossing of two mentally drawn lines: 1) from a point on a lower eyelid at distance of 1 cm from an internal corner of an eye to a corner of a mouth and 2) from an outside corner of an eye to the middle of an upper lip. At contact of a needle with a nerve of the patient feels the sharp pain irradiating in an upper lip and a wing of a nose. If the patient does not react on in a stake in an opening, then it is necessary to deepen a needle to the infraorbital canal on 1 — 1,5 cm. Ambassador A. there comes resistant anesthesia of an upper lip and wing of a nose. If sensitivity in a wing of a nose remained, painful attacks can proceed and is necessary additional And. nasal branch. For this purpose do in a stake to a bone at distance 1 cm from a wing of a nose and, having found a nerve, enter 0,5 ml of solution (fig. 4).
And. front palatal nerve make more often in addition to And. an infraorbital nerve when the patient continues to feel pains only during food and a conversation. For finding of a palatal opening it is necessary to draw mentally a line from the middle of the II painter perpendicularly to sutura mediana. To Eagle stick in a point on border between a lateral and average third of this line (fig. 7) to a bone and without special work find a palatal opening. At the time of developing of pain in infraorbital area enter 0,5 — 0,75 ml of alcohol with novocaine.
And. upper back alveolar nerves as the independent measure is applied seldom. However it is absolutely necessary the ambassador A, an infraorbital nerve if there was «a kurkovy zone» in the field of a transitional fold with back painters that it is easy to find by irritation of this place a finger. At a half-open mouth delay the pallet soft tissues of a cheek and stick a needle behind a skulo-alveolar crest in a transitional fold between II and III painters; advancing a needle at an angle 45 ° up and forward, bend around a convex part of a bone in the field of a maxillary hillock and enter 0,75 ml of solution. Need And. a zygomaticofacial nerve arises seldom. For its performance find a needle the opening of the same name, a cut it is usually located at a depth of 1 cm, and enter 0,5 ml of solution.
At neuralgia of the III branch depending on localization of «a kurkovy zone» And. mental, lingual, lower alveolar and buccal nerves are exposed. In most cases pains completely stop the ambassador A. one mental nerve, edge it is made in a mental foramen. This opening is usually located under septum alveolare between I and II premolar tooths. The mandible is covered average and index fingers in the field of premolar tooths. To Eagle stick to a bone in the location of an opening (fig. 5). Having groped an opening, the needle is slowly advanced in depth of the mandibular channel and at feeling the patient of an acute pain enter 1,0 — 1,5 ml of alcohol with novocaine. As a result And. there steps resistant anesthesia of a lip on 1 cm ahead from a corner of a mouth and below a red border. The anesthesia only in a chin does not lead to the termination of pains, in these cases it is required additional And. lip branch. By a needle perpendicularly to a bone do in a stake a little kzada from a mental foramen and enter 0,5 ml of solution.
Break of conductivity of a lingual nerve it is necessary when «the kurkovy zone» is localized in language or a gingiva of the last painters from the lingual party. In these cases the ambassador A. a mental nerve of pain in the field of its innervation stop, but patients continue to feel pains during food and a conversation. And. make at widely open mouth (fig. 6) a needle 5 cm long, to-ruyu stick to a bone in the middle of a front half of plica pterygomandibularis, at hit of a needle in a nerve of the patient feels sharp pain in language then enter 0,5 — 0,75 ml of solution (there has to occur total loss of sensitivity of front two thirds of language). This method of treatment with success is applied also at a glossodynia (see).
K A. the lower alveolar nerve resort in the following cases: 1) when the double injection of novocaine in a mental nerve does not give the termination of pains; 2) at an obliteration of a mental foramen or impossibility to find a mental nerve; 3) if «the kurkovy zone» is located in the field of one of the last painters, a trestle of an ear or a temple; 4) if ambassador A. a mental nerve of pain completely did not stop within 6 — 12 days, the Only place for endoneural And. the fillet (sulcus colli mandibulae) is, in Krom the nerve lies before an entrance to the mandibular channel (fig. 8). Technique And. the lower alveolar nerve it is similar to a so-called manual method of mandibular anesthesia With that essential difference that solution in number of 1,0 — 2,0 ml is entered surely endonevralno. In case of perineural administration of solution treatment by alcohol of an internal alate muscle is possible that leads to development of a lockjaw and the subsequent contracture. To avoid a similar complication, in all cases it is necessary to apply mechanotherapy.
Neuralgia buccal nerve meets very seldom. For And. its needle stick in the place where the trunk of a buccal nerve crosses a first line of a coronal shoot. To Eagle stick behind a molar pole, is about 1 cm higher than a chewing surface of teeth, direct it forward and a little knaruzha until it rests against a bone; here the needle is delayed back on 2 mm and enter 0,5 ml of solution. See also Anesthesia local , maxillofacial area.
Bibliography: Alekseev P. N. A method of alcoholization of operational wounds in fight against pains, Works Voronezhsk. medical in-that, t. 8, page 202, 1940; Bondarchuk A. V. Diseases of peripheral vessels, L., 1969; Nazarov N. N. Use of alcohol in nervous surgery, Saratov, 1928, bibliogr.; Polenov A. L. and Bondarchuk of A. V. Hirurgiya of the autonomic nervous system, page 292, 337, L., 1947; Razumovsky V. I. About a physiological extirpation of Gasser'ova of a node, the Russian doctor, No. 3, page 73, 1909; it, Alcohol in nervous surgery, Klin. medical, t. 5, No. 2, page 73, 1927; it, Observations over alcoholization of vessels and nerves, in the same place, t. 7, No. 23-24, page 1800, 1929; Shternberg O. A. Epileptiform neuralgia and its treatment by alcoholization, M., 1961; Leriche R. La chirurgie de la douleur, P., 1949; Schloesser, Zur Behandlung der Neuralgien durch Alkoholeinspritzun-gen, Berl. klin. Wschr., S. 82, 1906.
D.F. Skripnichenko; O. A. Shternberg (ostomies.).