Diseases of the nose and throat . thus controlled and we then shall be obligedto resort to some other method. Direct pressure by the finger, orby means of one of the various tonsillar hemostats (Fig. 96), should HEMORRHAGE IN TONSILLOTOMY. 253 be tried without wasting time over styptics (Fig. 97). Ligation ofthe tonsil after transfixing the stump with a tenaculum is sometimesfeasible; but it is not easy to ligate a tonsillar artery from whichbrisk hemorrhage is taking place in a nervous frightened child, oreven in an adult. The electric cautery, or Paquelin cautery willcheck persistent oozing
Diseases of the nose and throat . thus controlled and we then shall be obligedto resort to some other method. Direct pressure by the finger, orby means of one of the various tonsillar hemostats (Fig. 96), should HEMORRHAGE IN TONSILLOTOMY. 253 be tried without wasting time over styptics (Fig. 97). Ligation ofthe tonsil after transfixing the stump with a tenaculum is sometimesfeasible; but it is not easy to ligate a tonsillar artery from whichbrisk hemorrhage is taking place in a nervous frightened child, oreven in an adult. The electric cautery, or Paquelin cautery willcheck persistent oozing but will rarely control an arterial jet. Aningenious proposition by Levis succeeded in an obstinate case underhis care; the stump of the tonsil was transfixed by a tenaculum; itwas then twisted to bring the flat handle between the teeth and thejaws were bandaged together; on withdrawing the instrument nextday there was no return of hemorrhage. When hemorrhage is tobe apprehended from any source Seifert advises the use of the gal-. Mikulicz-Stoerk Tonsil Hemostat. vanocautery snare in operating and suggests that one be content toremove not more than three fourths of the tonsil, the latter precau-tion, however, appearing somewhat superfluous in addition to theformer. Ligation of the carotid artery for tonsillar hemorrhage has sev-eral times been done, but in at least one such case it seems clear thatthe bleeding was on the point of ceasing spontaneously. On ana-tomical grounds the external carotid, between its superior laryngealand ascending pharyngeal branches, would be the vessel indicatedfor ligation, but in view of the fact that the importance of this acci-dent has been vastly overdrawn a less formidable procedure wouldseem to be preferable. If a stump of tonsil has been left the loopof a cold-wire snare may be passed over its base and gradually tight-ened, or if the excision has been complete the tissues may be trans-fixed with a needle in a long handle and the wire slipped
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Keywords: ., bo, bookcentury1900, bookdecade1900, booksubjectnose, bookyear1903
