. Plexus. rom in front it is best to work up to the ridgefrom both directions. Where this is not possible, as fre-quently happens, it is best to wait until the upper part ofthe septum has been removed so as to allow more room. When the membranes are well freed from the entireconvexity of the septum a sharp moderately curved knife isused to cut through the thickness of the cartilage in musf be carefully done so as to cut down to the membranes of the other side, but not through them, Fig. is an extremely delicate part of the work and only Submucous Resection of Nasal Septum.
. Plexus. rom in front it is best to work up to the ridgefrom both directions. Where this is not possible, as fre-quently happens, it is best to wait until the upper part ofthe septum has been removed so as to allow more room. When the membranes are well freed from the entireconvexity of the septum a sharp moderately curved knife isused to cut through the thickness of the cartilage in musf be carefully done so as to cut down to the membranes of the other side, but not through them, Fig. is an extremely delicate part of the work and only Submucous Resection of Nasal Septum. F25 experience will prevent the operator occasionally cuttingthrough the membranes of the concavity. Through thishole in the cartilage, the blunt elevator is used to raise themembrane precisely as on the opposite side. The instrumentscan beguided by sight as itmoves under the membrane of theconcave side, Fig. IV. The sharp elevator will occasionallyhave to be used here also, and the membrane must be raised. Fig. III. Fig. IV. Buttonholing the cartilage. In Taken from another specimen order to show the technique, ihe showing instrument inserted whole membrane has been folded through opposite side, dissecting back. up membrane on concave side ot septum. as widely on the other side. We have now the frame workof the septum stripped of its mucoperiosteum on both sidesand cut through only a short distance back of the originalincision on the convex side. Through this cut, if well for-ward, the swivel knife can be placed astride of the quad-rangular cartilage, and with a steady pressure up, back,down 326 The Plexus. and forward, the entire cartilage necessary to remove cum-be cut away with one sweep and drawn out by forceps. The-instrument must be held under perfect control as a suddenquick lunge may tear away membrane and seriously mar thesuccess of the operation. After the removal of the cartilage in this manner andfrequently when the swivel knife is not used at all, the
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