Diseases of the nose and the accessory cavities / by W. Spencer Watson ; with special sections on diseases of the skin of the nose, on injuries, on rhinoplastic operations, and on ear-affections in their relation to intra-nasal diseases / by Robert Liveing, William Adams, and A.E. Cunningham.

  • Watson, W. Spencer (William Spencer), 1836-1906.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the nose and the accessory cavities / by W. Spencer Watson ; with special sections on diseases of the skin of the nose, on injuries, on rhinoplastic operations, and on ear-affections in their relation to intra-nasal diseases / by Robert Liveing, William Adams, and A.E. Cunningham. Source: Wellcome Collection.

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    however, not without risk, and its results are not per- manent ; as the gland is apt to enlarge again as soon as the wound closes, and it being the lateral lobes which cause the dyspnoea, no good can be obtained by removal of the isthmus if the former remain large. PalHative tracheotomy is hardly to be recommended, unless removal of the hypertrophied gland is impractic- able, as it gives the patient little chance of permanent cure, and may require the wearing of a very long canula to reach below the site of obstruction. Eemoval of one- half of the gland, and that portion of course from which the pressure seems to arise, is therefore the best operative measure to be adopted. The operation should be per- formed in the following manner. An incision should be made over the middle of the tumour of sufficient length to allow free manipulation of the tumour. Having cut through the skin, the rest of the tissues should be divided on a director down to the investing membrane, or fascia propria of the gland. Care should be taken as far as possible not to wound any veins. Venous haemorrhage occurs mainly at the early part of this operation. The fascia propria should then be divided upon the director, and the capsule of the gland will be exposed. Care should be taken not to tear the capsule as the veins lie in deep grooves on the surface of it; and beneath it they are very thin walled and may be easily torn. The rest of the oper- ation should be done with the fingers and handle of the scalpel, the gland being separated all round from the fascia propria. Arterial hsemorrhage comes from either the superior or inferior thyroid arteries, or exceptionally