Surgical therapeutics and operative technique . ound on theinner side towards the styloid process, or in front, beneath the ascendingramus of the inferior maxilla, which, in a recent case, was found excavatedand thinned as a result of the development of the tumour. 56 SURGICAL THERAPEUTICS AND OPERATIVE TECHNIQUE 2. Complete Extirpation of the Parotid Gland.—Complete extirpationof the parotid gland is carried out with the same technique. The principalpoint, when the surface of the tumour has been exposed, is to free itsperiphery at the most accessible point, and to penetrate beneath its deepsu
Surgical therapeutics and operative technique . ound on theinner side towards the styloid process, or in front, beneath the ascendingramus of the inferior maxilla, which, in a recent case, was found excavatedand thinned as a result of the development of the tumour. 56 SURGICAL THERAPEUTICS AND OPERATIVE TECHNIQUE 2. Complete Extirpation of the Parotid Gland.—Complete extirpationof the parotid gland is carried out with the same technique. The principalpoint, when the surface of the tumour has been exposed, is to free itsperiphery at the most accessible point, and to penetrate beneath its deepsurface in order to isolate it with the finger and the extremity of bluntscissors, which act, in the first movement, as a spatula, and then by divul-sion. If bleeding occurs, we must hasten to complete the procedure asrapid]y as possible. Wound of the external jugular vein or external carotid artery is of nogravity. Temporary haemostasis is secured by pressing into the wounda compress which is retained with the finger. When the tumour has been. Fig. 115.—Extirpation of a Voluminous Tumour of the Parotid of tumour out of wound, and section of its upper adhesions. luxated to the outside of the wound, we complete the section of its lastremaining attachments, and verifj^ the condition of the field of is eas}^ to recognize the calibre of the vessels divided by everting thecapsule of the tumour between the jaws of a ringed forceps. We fix ashort-jawed clawed forceps on the wounded vessel, and tie it with No. 5silk. If the haemorrhage seems to be serious, we can increase the cutaneousincision downwards with scissors so as to give more light. We then apply aseptic tamponing with drainage, and effect a temporaryreunion with clasps. These are removed on the second or third day, thetamponing is dispensed with, and a new reunion is effected with drainage. Total extirpation of the parotid gland requires section of the facialnerve. The patient should be warned b
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