Plastic surgery; its principles and practice . (i) Fistulae caused by lateral section of theduct, with limited traumatism of the cheek. (2)Fistulae caused by great destruction of the cheek,followed by contracted scars which occlude theduct, obliterating its normal orifice and lea\ingopen the skin wound. This is the most commonvariety. (3) Fistulae of the duct caused by infec-tion associated with destructive traumatism in-volving bone and soft parts. Many operations have been devised for the re-lief of this condition. The object of these opera-tions is to divert the flow of parotid secretion in
Plastic surgery; its principles and practice . (i) Fistulae caused by lateral section of theduct, with limited traumatism of the cheek. (2)Fistulae caused by great destruction of the cheek,followed by contracted scars which occlude theduct, obliterating its normal orifice and lea\ingopen the skin wound. This is the most commonvariety. (3) Fistulae of the duct caused by infec-tion associated with destructive traumatism in-volving bone and soft parts. Many operations have been devised for the re-lief of this condition. The object of these opera-tions is to divert the flow of parotid secretion intothe mouth from its abnormal external point of dis-charge. If this cannot be done by any of themeans at our command, it may be deemed advis-able to check the secretion entirely. Operations for the relief of fistulae of Stensonsduct vary with the position of the fistula; (i) A wire or rubber liga- •^ ^ cure IS inserted from w^hen it is anterior to the masseter muscle; (2) the buccal surface sowhen it is in the masseteric portion of the duct. Fig. 696.—Opera-tion for fistula of Sten-sons duct (Deguise).— When the Fistula is Anterior to theMasseter Muscle IS that it passes throughthe floor of the is tied or twistedtightly, and the tissueincluded will slough,thus making an openinginto the mouth. Thefistulous tract is then ex-cised and the edges areclosed. Von Langenbecks Operation.—A probepassed through the fistula into the portion of theduct next to the gland. The duct having been dissected out its freeend is drawn through an opening into the mouth, and sutured to thebuccal mucosa. The external wound is closed. This is the operationof choice when the duct is anterior to the masseter, but unfortunatelythe fistulae are usually found much further back. Deguises Operation.—From the fistula make two cm. {}^ inch) apart into the mouth. Pass through these per-forations an elastic ligature, a silver or lead wire, or a silk ligature, and 3S 594 PLAST
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgeryplastic, booky
