. Operative surgery. of the superior maxilla are then sawed through from behind forward tothe lachrymal bone, the saw here being made to pass in its course throughthe spheno-maxillary fissure. Or the superior maxilla can be divided in the line of the superior incision of the soft parts,thus leaving the orbital plate intact. Theosteo-cutaneous flap is now raised by an ele-vator carried beneath the malar bone andslowly lifted upward and inward toward thenose, the bones and soft parts of which forma hinge to the flap at that side. If the sawcan not be passed into the posterior nasalcavity even by
. Operative surgery. of the superior maxilla are then sawed through from behind forward tothe lachrymal bone, the saw here being made to pass in its course throughthe spheno-maxillary fissure. Or the superior maxilla can be divided in the line of the superior incision of the soft parts,thus leaving the orbital plate intact. Theosteo-cutaneous flap is now raised by an ele-vator carried beneath the malar bone andslowly lifted upward and inward toward thenose, the bones and soft parts of which forma hinge to the flap at that side. If the sawcan not be passed into the posterior nasalcavity even by the aid of a grooved director,the lips of the incision of the soft partsmay be drawn asunder, and the bone sawedfrom without inward and before backward. The Comments.—The operation is usuallyattended by quite severe haemorrhage, which,however, can be controlled readily by pressureand an occasional ligature. After the re-moval of the growth, the parts are adjusted&. and confined in position by sutures, etc. If. Pig. 842.—a. OlliersGuerins incisionsbecks incision. c. Langen- the growth to be removed be a large and vas-cular one, a preliminary tracheotomy shouldbe done. If it be malignant or very vascular, and have a large attachment, wedeem it a wise precaution to tie both external carotids prior to removal. Thedangers from haemorrhage will be lessened by this measure, and, moreover,the diminished vascularity of the parts will hinder the redevelopment of thegrowth. Dawbarn practices the removal of these vessels and for similarreasons. The division of the bones can be readily and advantageously done withan osteotome and mallet (Fig. 450), especially when the spaces at the backof the jaw are not sufficiently distended by the growth to permit a wise use OPERATIONS ON THE NOSE. 659 of the saw. The difficulty of raising the flap and of returning and properlyadjusting it, thereby incurring the dangers of necrosis, with consequent sepsisand non-union, are objectionable features of
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