. Manual of operative surgery. Fig. 139.—Dovvds operation. SUTTON S OPERATION II9 Trendelenburgs position ought to be used throughout the operation. Inoperating on cancer of the lip it is a good rule, where possible, to begin by dis-secting out the lymphatics which may be diseased. It is, of course, imperativeto remove all evidently involved lymphatics, but it is prudent to go furtherand remove the apparently unaffected ones next in order. For example: the sub-mental and submaxillary group of lymphatics appear healthy, or but veryslightly diseased: remove them and then excise the primary disea
. Manual of operative surgery. Fig. 139.—Dovvds operation. SUTTON S OPERATION II9 Trendelenburgs position ought to be used throughout the operation. Inoperating on cancer of the lip it is a good rule, where possible, to begin by dis-secting out the lymphatics which may be diseased. It is, of course, imperativeto remove all evidently involved lymphatics, but it is prudent to go furtherand remove the apparently unaffected ones next in order. For example: the sub-mental and submaxillary group of lymphatics appear healthy, or but veryslightly diseased: remove them and then excise the primary disease of the lip aswell as perhaps the fatty connections between the primary and the secondaryfoci of disease; again, the submental and submaxillary group are evidently dis-eased; expose the carotid group of lymphatics, excise them, as well as the sub-maxillary, etc. One great reason for beginning with the lymphatics is that byso doing the mouth is not penetrated until the difl&culties of the operation arepractically Fig. 140.—Suttons operation. (Sutton.) W. S. Sutton devised an ingenious and successful method of removingtumors involving both upper and lower lips at the angle of the mouth ( M. A., Aug. 20, 1910). Fig. 140 is self-explanatory. Grants operation issufficiently explained by Figs. 141 and 142. Nelaton and Ombredanne recommended the two following operations as themethods of choice in cancers of different extent. Method A. Step I.—Excise the cancer by a V-shaped incision. From the apex of the Vmake one or if necessary two incisions parallel to and a fingers breadth belowthe border of the lower jaw, outwards to the line of the carotid artery (Fig. 143).Excise the lymphatics extensively. 120 LOWER LIP Step 2.—Close the wound by suture, after providing for drainage (). Closure of the wound produces a very ugly deformity of the upper correct this make an angled incision E, B, C (Fig. 144) on each side of themouth. Suture the cut surface E
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