John Locke gave transient relief to a Countess who had a “flash of fire over the face which made her shreek out” with topical opium to her gums. Samuel Fothergill espoused that tic douloureux arose in the ganglion of the trigeminal nerve. Since medical therapy with opiates or tincture of hemlock provided no lasting relief, surgical extirpation of facial nerves were attempted leaving patients disfigured and with persistent pain.

J. M. Carnochan of New York City in 1856 put Dr. Rousset under chloroform anesthesia, lifted cheek skin, trephined  maxillary bone and entered maxillary sinus. Then Carnochan dissected along the maxillary nerve to the foramen rotundum, removed surrounding bone, elevated and extirpated Rousset’s trigeminal ganglion (TG).  He awoke pain free and remained so for years.   Carnochan reported 2 more operations with total relief of intractable pain. To avoid bleeding into the maxillary sinus, Frank Hartley of NYC in 1892 made a temporal bone flap, tied the middle meningeal artery (MMA) and gently elevated the patient’s temporal lobe covered by dura to expose foramina rotunda and ovale. He cut maxillary and mandibular divisions and removed bone to extirpate the TG. The patient was pain free of pain, had transient diplopia and permanent unilateral jaw weakness. Hartley’s operation was adopted in the US and Europe, but resulted in fatal tears of MMA. Harvey Cushing in 1899 devised a low temporal bone incision to avoid tearing the MMA in its groove. Cushing removed the TG of Captain Walker who had 2 worthless peripheral neurectomies and threatened suicide due to pain. Cushing’s technique was universally adopted for its safety and efficacy.