. Operative surgery. ke a second oneextending from the first along the body of thelower jaw; dissect and draw aside the flaps; avoid,if possible, the lower branches of the facial nerve;divide the stylo-hyoid, styloglossus, stylo-pharyn-geus, and the digastric musdes, if need be; ligatureand divide the facial artery and vein; draw the sub-maxillary gland forward, and the internal jugularvein and carotid arteries outward, exposing thepharyngeal wall. Introduce the forefinger into themouth and outline the extent of the disease, aidedby conjoined manipulation from without. Open thepharynx in front
. Operative surgery. ke a second oneextending from the first along the body of thelower jaw; dissect and draw aside the flaps; avoid,if possible, the lower branches of the facial nerve;divide the stylo-hyoid, styloglossus, stylo-pharyn-geus, and the digastric musdes, if need be; ligatureand divide the facial artery and vein; draw the sub-maxillary gland forward, and the internal jugularvein and carotid arteries outward, exposing thepharyngeal wall. Introduce the forefinger into themouth and outline the extent of the disease, aidedby conjoined manipulation from without. Open thepharynx in front of the disease from without with agalvano-cautery knife or with scissors, thence passingupward, backward, and downward, circumscribingthe disease widely and removing it along with the con-tiguous portion of the wall of the pharynx, leaving no lymphatic glandsbehind. The Remarks.—The author, in a recent severe case requiring excision ofthe ascending ramus of the jaw, carried the first {a h) incision along the lower. Fig. 828.—a h c. Cheeversincision, a c. Mikuliczsincision. —. Authorssecondary incision to a b. 646 OPERATIVE SURGERY. border of the horizontal ramus of the jaw instead of in the course describedabove. The second incision (dotted line) was made backward and down-ward from near to the center of the first, and the flaps were reflected inthe usual manner. On closing the external wound, the lower end of thesecond incision was situated admirably for the purposes of dependentdrainage. Czernys Method.—Introduce a tracheotomy tube, and tampon thepharynx; make an incision from the angle of the mouth downward andoutward to the anterior border of the masseter, thence downward to the levelof the hyoid bone; expose and divide the lower jaw just in front of the lastmolar tooth; draw the fragments apart and divide the buccinator, digastric,styloglossus, stylo-hyoid, and stylopharyngeus muscles; secure the facial andlingual vessels; avoid the salivary glands, and the lingua
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