Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . e through the lower lip and carried down over thechin and neck as far as the hyoid bone. Bleeding is checked, a centralincisor tooth is removed, and a hole drilled through the jaw on either side ofthe median line. The jaw is now divided by two oblique cuts so planned asto give immobilization after uniting the divided parts (Fig. 995). The twohalves of the jaw are then retracted and the mucous membrane and musclesdivided in the floor of the mouth. The tongue is dra
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . e through the lower lip and carried down over thechin and neck as far as the hyoid bone. Bleeding is checked, a centralincisor tooth is removed, and a hole drilled through the jaw on either side ofthe median line. The jaw is now divided by two oblique cuts so planned asto give immobilization after uniting the divided parts (Fig. 995). The twohalves of the jaw are then retracted and the mucous membrane and musclesdivided in the floor of the mouth. The tongue is drawn forward by a trans-fixion thread and its detachment proceeded with from below. Scissors areused. Bleeding vessels are secured. Most vessels can be controlled bytwisting. The lingual vessels are clamped preferably before their operation should be conducted with deliberation. As much of the tongueand tissue in the floor of the mouth as is necessary may be removed. Aftertreating the stump the jaw is wired together and treated thereafter as afracture. Drainage is provided in the lower end of the wound. The dissec-. Fig. 994.—Carcinoma of closed. Drain in place. 298 SURGICAL TREATMENT tion of the lymphatics of the neck may precede or follow the operation onthe tongue. This operation has the disadvantages that the after-treatment must beprolonged, and the attachments of the tongue are so loosened that the larynxis apt to lack anterior support. Its advantages are that it gives free accessfor securing the lingual vessels through the mouth, and lends itself especiallyto cases in which the floor of the mouth is involved. Comments.—Removal of the tongue through the mouth is most satis-factory. Excision through a submaxillary incision and excision after divisionof the lower jaw are best reserved for the peculiar cases. It should be borne in mind that recurrence after operation for epitheliomaof the tongue is usually in the lymphatics, showing that the diff
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
