Surgical therapeutics and operative technique . Fig. 101.—Wound formed by Extirpation of Terebrating Epithelioma of Buccal Commissure. Coaptation of large external autoplastic flap. 48 SURGICAL THERAPEUTICS AND OPERATIVE TECHNIQUE Epithelioma adherent to the Margin of the Orbit. When the tumour is adherent to the periosteum of the orbital margin,or has involved the adherent bone, we must include the osseous tissue inour resection. Operation—First Stage: Incision of the Skin.—The tumour is cir-cumscribed as an elliptical incision involving the periosteum, and the sub-jacent superior maxilla is
Surgical therapeutics and operative technique . Fig. 101.—Wound formed by Extirpation of Terebrating Epithelioma of Buccal Commissure. Coaptation of large external autoplastic flap. 48 SURGICAL THERAPEUTICS AND OPERATIVE TECHNIQUE Epithelioma adherent to the Margin of the Orbit. When the tumour is adherent to the periosteum of the orbital margin,or has involved the adherent bone, we must include the osseous tissue inour resection. Operation—First Stage: Incision of the Skin.—The tumour is cir-cumscribed as an elliptical incision involving the periosteum, and the sub-jacent superior maxilla is exposed with a Fig. 102.—Wound formed by Extirpation of Terebrating Epithelioma OF Buccal Commissure. Terebrating epithelioma of cheek. Immediate autoplasty. Operation is comiDleted. Appearance of sutures. Second Stage.—We extirpate, as nearly as possible in a single mass,the tumour with affected bone, the section of the latter being made witha strong List ons forceps. Third Stage.—Formation of a suitable autoplastic flap. Fourth Stage.—Reunion of the skin with interrupted suture. When the tumour is of irregular outlines, it may be advantageous toprepare two or three small cutaneous flaps in stellate form. OPERATIONS ON THE HEAD 49 Epithelioma of the Mucous Membrane. Epithelioma of the mucous membrane should be removed with a liberalmargin, and preferably vnth. the help of a cutaneous incision, which givesmore light. The mucous membrane and the skin are sutured latter, in a case of infiltrating and recurring epithelioma, should beresected over a wide area. Operation—^First S
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