Removal of a cancerous tumour from below the tongue : with some remarks on the operative surgery of the tongue / by John Paul.

  • Paul, John.
Date:
[1858]
Catalogue details

Licence: Public Domain Mark

Credit: Removal of a cancerous tumour from below the tongue : with some remarks on the operative surgery of the tongue / by John Paul. Source: Wellcome Collection.

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    the exception of a small portion at the chin, which healed by granu¬ lation. The patient was discharged on the 26th July, being fully recovered in every respect from the effects of the operation, with the exception of the slight exfoliation that will take place from the bone, and the wound being healed more than a week. On reviewing this case, I cannot resist alluding to the facility with which I was enabled to secure the divided arteries; and, in planning the operation, I had great misgivings on this point, be¬ cause I was afraid that, as vessels of considerable size, especially the subdingual branches of the lingual artery, must unavoidably be cut, there would be great difficulty in laying hold of them in the confined and hollow space in which they would be. This, however, was not the case, as they were tied with as much ease as if they had been on the face of a stump. The facility thus afforded me in tying the arteries was owing, I am confident, to the removal of the front of the maxilla ; and from this the idea is suggested to my mind, that in cases of urgency, requiring the removal, either by ligature or excision, of any portion of the tongue, or of the entire organ, the same procedure may be advantageously had recourse to, because by it, I think, perfect command is given over the vessels of the tongue in any operative proceeding. Judging, then, from the ease which I experienced in tying the vessels in the floor of the mouth in the case under consideration, I think it is not unreasonable to infer that, if the front of the jaw is removed, the tongue itself, or any portion of it, may be removed, and the vessels tied with the same ease. The practicability, at least, of accomplishing this is so strongly impressed upon my mind, that, if the operation be undertaken, there will be, I think, but little risk of failure. It may at first sight appear appalling to remove a portion of the jaw in order to operate on the tongue; but if, by so doing, opera¬ tions can be performed on it with less hazard to life and greater certainty to stay the progress of a horrible and fatal disease, appal¬ ling as it may be, I think it becomes justifiable when its object is to accomplish an end so important and so desirable. The mere re¬ moval of a portion of the jaw involves no consequences of serious import to life. It may be done with great rapidity, and made a painless operation by means of chloroform. I may remark, that in the case detailed I did not use chloroform, —the use of it in operations of the mouth being a vexed question. No blood, however, was swallowed ; and I am satisfied that it might have been used, not only with impunity in this respect, but with much comfort to the patient, in annulling the suffering of so painful an operation. Danger of haemorrhage in excising cancerous tumours situated towards the root of the tongue, and even difficulty in surrounding them with ligatures, have ever been barriers to operative interfer¬ ence. To obviate the one and the other, operations on the tongue