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From the Archives of the Archives
February 1999

A look at the past . . .

Arch Ophthalmol. 1999;117(2):201. doi:10.1001/archopht.117.2.201

The favorable but incomplete results of partial resection or cutting through the cervical sympathetic in Graves's disease have led Jounesco to undertake its complete bilateral resection. An incision through the skin beginning at the mastoid process and following the margin of the sterno-cleido-mastoid to the clavicle, gives access to the jugular vein which is ligated in two places and divided. The exposing of the posterior margin of the sterno-cleido-mastoid necessitates cutting the branches of the cervical plexus. The trunk of the cervical sympathetic must be sought for in the middle of the region of operation. The isolated nerve trunk serves as a guide for finding the upper, middle, and lower cervical ganglia. In three of his six operations the author was forced to omit the resection of the lower ganglion. The removal of the upper ganglion immediately brings about contraction of the pupil and congestion of one half the face and secretion of saliva and tears. These symptoms soon pass off and the results of the operation are trivial. Among the six patients two had Basedow's disease. The resection of the sympathetic led in both cases to the disappearance of the exophthalmus, with decrease in size of the thyroid and a slight lessening of the frequency of the pulse.

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