CLEGHORN ON EXCISION OF THE TONGUE.
of the anterior half of the tongue and
EXCISION OF THE
THREE CASES OF
TONGUE BY SCISSORS. By
James Cleg horn,
In the first of these was removed
both
by
wards
Surgeon. of the
the whole
what is called Billroth's
arteries
lingual
cases
Civil
operation, ligatur-
the tongue
cases
only partially excised, linguals ly tied, and the operation is known by the
tongue
been
having previously
ed in the neck ; in the other
were
not
was
previous-
the
name
of
Whitehead's. The
lingual
arteries
are
incision directed upwards,
passing
The incision
deeply
reached
must be
situated than
through a curved convexity of the curve of the hyoid bone.
the
the great horn
over
the artery is more would expect from a dissect-
free,
one
as
A portion of the submaxilexperience. lary gland covers the situation of the artery, and should be carefully reflected upwards. The mouth
]ng
is
room
kept
roller
open with
a
in
Mason's gag ;
these
cases a
duty for the gag. A strong ligature is passed through the tongue and held by an assistant. The fnenum and tissues connecting the
bandage
did
divided by scissors, the sides
with the floor of the mouth
tongue pair of strong, flat, blunt-pointed are then freed, the tongue is pulled well forwards and removed quickly by a few sharp cuts of the scissors. When the division is completed the result is rather alarming, as the haemorrhage is so proluse
a
and a
apparently
sponge soon,
from the
difficulty,
linguals, picked
be
arrests all
these
and
are
Firm pressure
uncontrollable.
however,
bleeding
can,
up either with
after
forceps
or
a
with
except little
tenacu-
lum and tied. The after
treatment
consists in frequent washings
of the mouth with Condy's
solution of boracic acid
fluid,
or
with
a
saturated
these may be used alternately. When the whole tongue is removed the patient must be fed through the nose for the first three days, m
partial excision he The main points
are, to
keep
; or
can
be fed by the mouth.
to be attended to
the mouth
as
widely
open
in the operation as
possible,
and
incline the head with pillows as to favour the escape of blood from the mouth. The lower angle of the mouth should be down by
so
to
forcibly dragged assistant, so as to ensure the escape of blood. Constant sponging is also required to prevent any blood passing through the uncovered glottis.
the
finger
131
of an
Case i.?A male, aged 55. years, admitted on 15th December last, with epithelioma, involving the whole
on
was
glands
were
Both
side
the left
There
the level
to
of the tonsil.
the dorsum.
ulceration in
deep
extending backThe
not affected.
lingual'
arteries
tied above the
were
hyoid
bone and the whole of the tongue with a portion of affected tissue in the vicinity of left tonsil and angle of jaw,
was
removed with scissors.
haemorrhage which
was
the
from
arrested
by
There
whole of the
pressure, and
surface,
cut
vessel
one
free
was
near
left tonsil was tied. The
patient days.
He
healed
completely
in neck healed Case 2.?A
July
with
fed
was
for three
by
was
on
wit;h milk through the nose discharged with the wound
the 4th January.
The wounds
first intention. 50 years, admitted implicating the whole
male, aged
epithelium
anterior half of the left side of the tongue. was
enlarged glands
7th
of the
The tongue There was a
fixed to the floor of the mouth.
bunch of hard
on
below the
jaw
on
the
left side. The
diseased portion
removed
was
February by cutting to right backwards to angle of left jaw.
side of
on
the 12th
tip obliquely
haemorrhage was profuse, and great difficulty experienced in arresting it. One vessel was tied. The glands affected were removed through an incision The
was
Both wounds healed
in the neck.
patient
left
hospital
the
on
quickly,
and the
19th February.
3.?Male, aged 50 years, admitted on 23rd February, with epithelioma affecting the middle of Case
left side of tongue. Glands not affected. The left half of tongue was removed on 27th February. The
bleeding
was
profuse,
One vessel
pressure. The patient left the
but
was
easily
was
hospital
on
with the wound quite healed.
Mirzapore,
nth
arrested
by
tied.
April, 1884.
the
14th
March
of the anterior half of the tongue and
EXCISION OF THE
THREE CASES OF
TONGUE BY SCISSORS. By
James Cleg horn,
In the first of these was removed
both
by
wards
Surgeon. of the
the whole
what is called Billroth's
arteries
lingual
cases
Civil
operation, ligatur-
the tongue
cases
only partially excised, linguals ly tied, and the operation is known by the
tongue
been
having previously
ed in the neck ; in the other
were
not
was
previous-
the
name
of
Whitehead's. The
lingual
arteries
are
incision directed upwards,
passing
The incision
deeply
reached
must be
situated than
through a curved convexity of the curve of the hyoid bone.
the
the great horn
over
the artery is more would expect from a dissect-
free,
one
as
A portion of the submaxilexperience. lary gland covers the situation of the artery, and should be carefully reflected upwards. The mouth
]ng
is
room
kept
roller
open with
a
in
Mason's gag ;
these
cases a
duty for the gag. A strong ligature is passed through the tongue and held by an assistant. The fnenum and tissues connecting the
bandage
did
divided by scissors, the sides
with the floor of the mouth
tongue pair of strong, flat, blunt-pointed are then freed, the tongue is pulled well forwards and removed quickly by a few sharp cuts of the scissors. When the division is completed the result is rather alarming, as the haemorrhage is so proluse
a
and a
apparently
sponge soon,
from the
difficulty,
linguals, picked
be
arrests all
these
and
are
Firm pressure
uncontrollable.
however,
bleeding
can,
up either with
after
forceps
or
a
with
except little
tenacu-
lum and tied. The after
treatment
consists in frequent washings
of the mouth with Condy's
solution of boracic acid
fluid,
or
with
a
saturated
these may be used alternately. When the whole tongue is removed the patient must be fed through the nose for the first three days, m
partial excision he The main points
are, to
keep
; or
can
be fed by the mouth.
to be attended to
the mouth
as
widely
open
in the operation as
possible,
and
incline the head with pillows as to favour the escape of blood from the mouth. The lower angle of the mouth should be down by
so
to
forcibly dragged assistant, so as to ensure the escape of blood. Constant sponging is also required to prevent any blood passing through the uncovered glottis.
the
finger
131
of an
Case i.?A male, aged 55. years, admitted on 15th December last, with epithelioma, involving the whole
on
was
glands
were
Both
side
the left
There
the level
to
of the tonsil.
the dorsum.
ulceration in
deep
extending backThe
not affected.
lingual'
arteries
tied above the
were
hyoid
bone and the whole of the tongue with a portion of affected tissue in the vicinity of left tonsil and angle of jaw,
was
removed with scissors.
haemorrhage which
was
the
from
arrested
by
There
whole of the
pressure, and
surface,
cut
vessel
one
free
was
near
left tonsil was tied. The
patient days.
He
healed
completely
in neck healed Case 2.?A
July
with
fed
was
for three
by
was
on
wit;h milk through the nose discharged with the wound
the 4th January.
The wounds
first intention. 50 years, admitted implicating the whole
male, aged
epithelium
anterior half of the left side of the tongue. was
enlarged glands
7th
of the
The tongue There was a
fixed to the floor of the mouth.
bunch of hard
on
below the
jaw
on
the
left side. The
diseased portion
removed
was
February by cutting to right backwards to angle of left jaw.
side of
on
the 12th
tip obliquely
haemorrhage was profuse, and great difficulty experienced in arresting it. One vessel was tied. The glands affected were removed through an incision The
was
Both wounds healed
in the neck.
patient
left
hospital
the
on
quickly,
and the
19th February.
3.?Male, aged 50 years, admitted on 23rd February, with epithelioma affecting the middle of Case
left side of tongue. Glands not affected. The left half of tongue was removed on 27th February. The
bleeding
was
profuse,
One vessel
pressure. The patient left the
but
was
easily
was
hospital
on
with the wound quite healed.
Mirzapore,
nth
arrested
by
tied.
April, 1884.
the
14th
March
