. Manual of operative surgery. fter anesthesia is induced in the usual manner Kanavel con-tinues the administration of ether by the rectal method, while Halstead per-formiS tracheotomy and gives chloroform through a Trendelenburg the author it seems that laryngotomy and the use of chloroform throughButlins cannula is simpler and safer than tracheotomy. The advantage ofanesthetizing through a tracheotomy or laryngotomy cannula over the rectalmethod consists in the ability to plug the pharynx thoroughly and the avoid-ance of all respiratory troubles. Before giving the anesthetic, plug
. Manual of operative surgery. fter anesthesia is induced in the usual manner Kanavel con-tinues the administration of ether by the rectal method, while Halstead per-formiS tracheotomy and gives chloroform through a Trendelenburg the author it seems that laryngotomy and the use of chloroform throughButlins cannula is simpler and safer than tracheotomy. The advantage ofanesthetizing through a tracheotomy or laryngotomy cannula over the rectalmethod consists in the ability to plug the pharynx thoroughly and the avoid-ance of all respiratory troubles. Before giving the anesthetic, plug the nasalpassages carefully from the anterior nares to the sphenoidal cells with strips ofgauze soaked in adrenalin solution. The Operation. Step i.—Tampon the pharynx. Remove the adrenalinpack. Raise the upper lip. Make a horizontal incision through the mucosa ofthe lip about % inch from the muco-cutaneous junction and parallel to thealveolus. Through this wound dissect upwards freeing the nose from its Fig. 41.—Hypophysectomy. {Kanavel, Jour. A. M. A.) Step 2.—With strong scissors or bone forceps divide the septum along itsinferior attachments (line b, Fig. 41). Divide the attachment of the septum tothe vertical plate of the ethmoid (line a, Fig. 41). Turn the nose and with itthe separated part of the septum upwards on to the forehead. Step 3.—Remove the lower and middle turbinates, the vomer and the per-pendicular plate of the ethmoid. The anterior wall of the sphenoidal sinus isnow exposed. Step 4.—Penetrate the anterior wall of the sphenoidal sinus. Sometimesthe tumor will now appear having eroded the sella turcica. If this has notoccurred, open the sella turcica by means of a long narrow chisel. Whileopening the sella turcica it is of prime importance to adhere strictly to themiddle line for fear of damaging the carotid arteries and the optic nerves. Step 5.—Treat the disease by evacuating any cyst which may be present orgently curetting
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