Operative surgery . n of thegenio-hyo-glossus muscle,- and if possibleturned outward, and the tissues separatedback to the point of posterior section;the bone is then divided at this lattersituation with a saw, the fragment re-moved, and the wound dressed as before. The Operation of Excision of a Lat-eral Half of the Lower Jaw.—Commencethe incision about an inch and a halfbelow the zygoma, and carry it downwardalong the posterior border of the ramusand beneath the body of the jaw to thesymphysis menti, carefully exposing the facial artery and tying it. If theoperation be for necrosis this inci
Operative surgery . n of thegenio-hyo-glossus muscle,- and if possibleturned outward, and the tissues separatedback to the point of posterior section;the bone is then divided at this lattersituation with a saw, the fragment re-moved, and the wound dressed as before. The Operation of Excision of a Lat-eral Half of the Lower Jaw.—Commencethe incision about an inch and a halfbelow the zygoma, and carry it downwardalong the posterior border of the ramusand beneath the body of the jaw to thesymphysis menti, carefully exposing the facial artery and tying it. If theoperation be for necrosis this incision will be sufficient; if for other disease,the lower lip is cut perpendicularly through its center to meet the longi-tudinal incision (Fig. 384, h). The bone is exposed in front by peeling offthe periosteum and sawed through just to the outer side of the insertionof the genio-hyo-glossus muscle (Fig. 385, G) if possible, the end of the por-tion to be removed is pulled outward, and the remaining attached tissues. Fig. 384.—Lines of incision in the re-moval of upper and lower Langenbeck. &, V. Removal oflower jaw. 376 OPERATIVE SURGERY. separated either by cutting or by a periosteotome, back to the beginning ofthe incision. Depress the fragment forcibly;, and if possible detach the tem-poral muscle with scissors orthe periosteotome, otherwise di-vide the coronoid process witha fine saw; turn the bone out-ward and sever the insertions ofthe pterygoid muscles, beingcareful to avoid cutting thelingual nerve; draw the boneforward forcibly and twist itfrom its socket (Fig. 386). If the primary incision besufficient to expose the boneabove the seat of the disease,the diseased portion is removedand the upper part allowed toremain. If, however, it be im-portant to accomplish the com-plete removal, extend the in-cision upward to the neck of thebone (Fig. 384, &), avoiding, ifpossible, Stensons duct and thecervico - facial branch of thefacial nerve, and enucleate theFig. 385
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