A manual of operative surgery . and mallet in the form of a quadrilateral piece of nasal mucous membrane is divided, and as much of the vomerremoved as is necessary. An entrance into the naso-pharyngealregion is thus effected. After the polyp has been dealt with, thecleft in the palate is closed by staphylorraphy. (See Bull, de la Chir., tome L, page 159.) Annandales Operation.—Professor Annandale has demon-strated (Lancet, January 26, i88q) that when the alveolar margin CHAP. XIV] NASAL POLYPUS 283 and palatal portions of the upper jaw have been divided along theircentre from
A manual of operative surgery . and mallet in the form of a quadrilateral piece of nasal mucous membrane is divided, and as much of the vomerremoved as is necessary. An entrance into the naso-pharyngealregion is thus effected. After the polyp has been dealt with, thecleft in the palate is closed by staphylorraphy. (See Bull, de la Chir., tome L, page 159.) Annandales Operation.—Professor Annandale has demon-strated (Lancet, January 26, i88q) that when the alveolar margin CHAP. XIV] NASAL POLYPUS 283 and palatal portions of the upper jaw have been divided along theircentre from before backwards, and the bony septum of the nose cutthrough (the anterior nares having first been exposed by Rougesplan), the two portions of the upper jaw can be separated to the extentof from half an inch to one inch, so as to give access to the posteriornares and base of the skull. Professor Annandale reports threeexamples of the operation. In one a preliminary tracheotomy wasfound necessary. All three patients FIG. 302.—NELATONS OPERATION FOR NASAL POLYPUS. The following are the steps of the operation :— 1. The anterior nares are exposed by freely dividing the mucousmembrane connecting the upper lip with the superior maxilla, andturning the lip upwards according to the plan of Rouge (page 284). 2. The bony septum of the nose is divided along its attachmentto the maxilla with cutting forceps. * 3. A gag having been introduced, an incision is made throughthe muco-periosteal covering of the hard palate in the median keyhole saw is then introduced through the nose, and the alveolarmargin of the upper jaw and the entire hard palate are sawn through 284 OPERATIONS ON HEAD AND NECK [part in in the same line. 1,1: may be necessary to extract an incisor to effect soft palate may or may not require division. This will dependupon the size and attachments of the growth. In two of the reportedcases it was divided ; in one it was not. 4. The right and l
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