Operative surgery . edicated with an astringent or stimulant, or the division andstitching outward of a i)ortion of the wall of the cyst, may be practiced ifsimpler means fail. Removal of Tumor of Tonsil and Pillar of Fauces.—This operation ispracticed for the purpose of removal of malignant disease of the tonsil, withor without involvement of contiguous tissues. In the simpler forms thedisease can be removed through the mouth. But if the disease be exten-sive, and evidences of deep tissue and lymphatic involvement be noted, theapproach should be made from the neck (pharyngotomy). In either in
Operative surgery . edicated with an astringent or stimulant, or the division andstitching outward of a i)ortion of the wall of the cyst, may be practiced ifsimpler means fail. Removal of Tumor of Tonsil and Pillar of Fauces.—This operation ispracticed for the purpose of removal of malignant disease of the tonsil, withor without involvement of contiguous tissues. In the simpler forms thedisease can be removed through the mouth. But if the disease be exten-sive, and evidences of deep tissue and lymphatic involvement be noted, theapproach should be made from the neck (pharyngotomy). In either in-stance a careful study of the important nervous and vascular relations to thediseased structure should be made. The Anatomical Points.—The tonsil in health corresponds to the angle ofthe lower jaw. It is a vascular structure receiving branches from the facial,internal maxillary, lingual, and ascending pharyngeal arteries. The internalcarotid lies at the outer and posterior aspect of the tonsil, at a distance of. Fig. 744.—Ranula. 576 OPERATIVE SURGERY. about three fourths of an inch, separated from it by the muscular andfibrous structures of tlie pharynx, the styloglossus, and stylopharyngeusmuscles. The glosso-pharyngeal nerve has a substantially similar associa-tion. The removal of the tonsil for malignant disease can be carriedou through the mouth or through an incision in the neck. The formerroute is advisable when the growth is limited to the tonsil, and even extendsto the base of the tongue, and is not attended with glandular some instances either tracheotomy with pharyngeal plugging, or splittingof the cheek, and ligature of the external carotid, may be practiced, especiallythe latter, if for no other reason than that of lessening, for a time, at least,the blood supply of the diseased part. The Operation.—Fix the mouth widely open with the gag and raise theshoulders so as to expose the parts to a good light; seize the diseased tonsilwith forceps o
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