A manual of diseases of the ear, for the use of students and practitioners of medicine / by Albert H. Buck.

  • Buck, Albert H. (Albert Henry), 1842-1922.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the ear, for the use of students and practitioners of medicine / by Albert H. Buck. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    -L 3 ft ■ _ .. 2^ = of certain fixed points which are in view before the operator. Thus, for example, the principal fixed point is the curving bony margin of the orifice of the external auditory canal. By crowd- ing the anterior flap of the wound well forward, a good view of this curving edge may be obtained. The antrum, as will be seen by study of Fig. 84, is situated at the intersection of two planes: a vertical transverse plane which passes in close proximity to the posterior part of this curving margin, and a horizontal plane which passes through the upper part of the same bony margin. The linea temporalis is another fixed point which will prove use- ful in preventing us from locating the antrum at too high a level; for this cavity lies below the level of this curving line. After a free opening has been established in the antrum, and after all jagged surfaces have been properly smoothed, a careful search should be made in the antrum and immediate vicinity for chips or fragments of bone. For this purpose the smaller-sized curette with rounded edges will be found a useful instrument. The next step in the operation is to inject a tepid ( about 100° F.) solu- tion of bichloride of mercury (1 part to from 3000 to 5000 parts of water) into the antrum and middle ear by means of a nozzle appreciably smaller than the artificial opening made by the chisel. Such a noz- zle is shown in the accompanying cut. In addi- tion to washing out the antrum we should irrigate thoroughly every part of the wound with the bi- chloride solution. Then the soft parts should be readjusted as accurately as possible in their nat- ural relations, and two or three deep sutures should be used in holding the opposite edges of the hori- zontal upper part of the wound in close apposition. As the strain upon this part of the wound is very great it is important that careful attention should be paid to this step of the opera- tion. The vertical portion of the wound is to be left open. The German surgeons recommend that a drainage tube be introduced through this part of the wound into the antrum, or at least as far inward as to the orifice of the artificial opening into the antrum, and left there for a period of several weeks. My own experi- ence justifies me in saying that this procedure is entirely unneces- sary. In fact. I believe that it only serves to prolong materially the healing of the wound. The final dressings should be as simple as possible. A small piece of sheet-lint, dipped in a weak solution of bichloride of mercury and anointed with carbolated vaseline, mav be laid over