. Diseases of the ear; a text-book for practitioners and students of medicine. themanubrium and severingthe tendon as the incis-ion is extended. Wheretenotomy is deemed ad-visable in cases of resid-ual purulent inflamma-tion, a large perforation being present, no preliminary in-cision is necessary, the knife being introduced through theexisting perforation ; the tendon is severed either from belowupward, or in the reverse direction, according to the specialtopography of the case. (b) Division of the Anterior Ligament of the Malleus.—Thismeasure was advocated by Politzer * in cases of marked re
. Diseases of the ear; a text-book for practitioners and students of medicine. themanubrium and severingthe tendon as the incis-ion is extended. Wheretenotomy is deemed ad-visable in cases of resid-ual purulent inflamma-tion, a large perforation being present, no preliminary in-cision is necessary, the knife being introduced through theexisting perforation ; the tendon is severed either from belowupward, or in the reverse direction, according to the specialtopography of the case. (b) Division of the Anterior Ligament of the Malleus.—Thismeasure was advocated by Politzer * in cases of marked re-traction of the membrana tympani, it being found in severalinstances that tenotomy of the tensor tympani alone did notallow the parts to resume their normal position, although thiswas possible if the anterior ligament had been severed. The membrane is punctured just in front of the short pro-cess with a short curved knife, with the cutting edge directedupward* The knife is carried inward almost to the bony wall,when the handle is depressed, crowding the edge against the. Fig. 132.—Tenotomy of tensor tympani frombelow upward. Diseases of the Ear, Am. edition, Philadelphia, 1SS3, p. 379. 496 MIDDLE-EAR OPERATIONS. ligamentous tissue in the anterior fold, which is divided as theknife is withdrawn. (c) The Division of Adhesions^ the Result of Suppurative orNonsuppurative Inflammation.—We may divide these adhesionsaccording to their location into two classes: 1. Adhesions about the stapes itself. 2. Adhesions between the malleus and incus and innertvmpanic wall, or tense bands immobilizing the entire ossicularchain, the articulations between the various ossicles beingintact. When the rigidity depends upon adhesions about thestapes itself as the result of a purulent otitis, the incudo-sta-pedial articulation having been destroyed, we find the pelvisovalis occupied by a mass of dense tissue which frequentlychanges the appearance completely. The head of the stapesmay present onl
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