. Manual of operative surgery. in, Op Surg. Malignant Dis., second, ed., Brit. Med. Jour., Feb. 15, 1905. 166 TONGVE local disease with ^i inch of apparently healthy tissues around it in everydirection. Where the disease is on the border of the tongue, it is best to removethat half of the tongue to an inch behind the cancer. After about nine days, when the patient is able to take plenty of liquid food,proceed to Step 2. Step 2.—Make an incision along the anterior border of the sternomastoidfrom near the mastoid process to the sternoclavicular articulation. Make anincision from the symphysis me
. Manual of operative surgery. in, Op Surg. Malignant Dis., second, ed., Brit. Med. Jour., Feb. 15, 1905. 166 TONGVE local disease with ^i inch of apparently healthy tissues around it in everydirection. Where the disease is on the border of the tongue, it is best to removethat half of the tongue to an inch behind the cancer. After about nine days, when the patient is able to take plenty of liquid food,proceed to Step 2. Step 2.—Make an incision along the anterior border of the sternomastoidfrom near the mastoid process to the sternoclavicular articulation. Make anincision from the symphysis menii to meet the previous incision, just abovethe thyroid cartilage. Reflect the two triangular flaps of skin thus outlinedand expose the platysma myoides and fat of the anterior triangle of the neck. Step 3.—Beginning below, expose the sternomastoid and retract it back-wards. Expose the carotid packet of vessels, dissecting from below upwards,and separate from it every particle of fat, whether superficial or deep, anterior. Fig. 262.—Butlins method for excision of the indicating the position of the most important lymph nodes, all of which are supposed to have beendissected out and removed, i. Location of submental group lymph nodes. 2. Location of submaxillarygroup lymph nodes. 3. Location of parotid group lymph nodes. 4. Location of carotid group lymphnodes. or posterior. Be careful to remove the fat between the parotid and the this fat ought to be left attached to that of the rest of the anterior triangle,otherwise the operation is liable to be incomplete (Fig. 262). Working fromthe region of danger (carotid packet) and from below upwards, remove enmasse all the fat in the anterior triangle and with it the submaxillary salivarygland, leaving the muscles quite bare. In the submental region complete thedissection by searching between the geniohyoid muscles, lest a gland be over-looked. If the disease involves the contents of the carotid packet, t
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