Case of osteo-sarcoma of the lower jaw, removed by James Syme.

  • Syme, James, 1799-1870.
Date:
[1828]
Catalogue details

Licence: Public Domain Mark

Credit: Case of osteo-sarcoma of the lower jaw, removed by James Syme. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ture, though inconvenient to myself, I preferred as being most conducive to the prevention of suffocation from hemorrhage during the operation, I made an oblique incision by running a sharp pointed knife through the lip, from the right angle of the mouth to the base of the jaw, where I proposed to divide it, viz. at the second bicuspid tooth, which had been removed the evening before. Having exposed the external surface of the bone at this part, I divided it partially with the saw, and easily com- pleted what remained by means of the cutting pliers. The inferior coronary artery, which Dr BaUingall had prevented from bleeding by compressing it in the lip, was then tied. I next made a long semicircular incision from the left angle of the mouth, in the direction of the base and ramus of the jaw, and terminating over the condyle. Having secured the facial artery, and two transverse branches of the temporal, I dissected down the large flap thus formed quite to the neck, so as to let Dr BaUingall feel the carotid lying in the muscular interspace, and ready to be compressed if there should be occasion. 1 then made another curved incision in a similar direction, commen- cing from the mouth, at such distance above the former as to' include a portion of the cheek, which was firmly adherent to the tumour; and having dissected up this flap, divided the mas- seter muscle, so as to expose the whole external surface of the tumour. The next step was to divide the mucous membrane of the mouth. This rendered the tumour much more moveable, and enabled me to expose the coronoid process, divide the tem- poral muscle, and open the articulation at its fore part. I had then merely to cut closely round the condyle, and detach the pterygoid, mylohyoid, and other muscular connections. The operation occupied twenty-four minutes; but all this time was not employed in cutting, as I frequently allowed a little re- spite, to prevent exhaustion from continued suffering. The patient bore it well, and did not lose more than seven or eight ounces of blood. His breathing was never in the slightest de- gree affected. After placing a few folds of caddis in the great cavity left by the tumour, which weighed 4^tbs., I brought the integu- ments together on the left side of the face, in a triangular Ibrm, and retained the edges in contact by the twisted suture. The incision on the right side was dressed in the same way. Two or three turns of a roller were then put round the chin and head, 80. as to support the relaxed integuments. The patient made no complaint of any sort after the opera- tion. His pulse for the first two days was about 100, but soft, and gradually subsided to the natural standard. He slept well; had an appetite for his food, viz. beaf-tca and whey, which were