Central myxo-sarcoma of the right superior maxilla : removal of entire maxilla and portion of malar bone / by John L. Neilson.

  • Neilson, John L.
Date:
[1880?]
Catalogue details

Licence: Public Domain Mark

Credit: Central myxo-sarcoma of the right superior maxilla : removal of entire maxilla and portion of malar bone / by John L. Neilson. Source: Wellcome Collection.

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    had bulged into the free cavity, and that the left maxilla was not impli¬ cated ; on both sides the mass was so immovable, and the teeth so deeply imbedded in it, that exploration was almost impossible. The patient was fed through a tube, about the size of a No. 18 catheter, passed into the cavity of the left cheek and around the tuberosity of the maxilla. There was remarkably little emaciation or cachexia, considering the history of the growth, and the great distress of the patient at the mechani¬ cal interference with respiration and alimentation, at the extremely foetid odour, and the constant dribbling, both into the fauces and externally, which deprived him of sleep ; he had not had any pain since the protru¬ sion of the masses through the walls of the antrum in the early weeks of the disease ; submaxillary glands were not affected, vision was not im¬ paired, and his vegetative functions were well performed. A consultation decided upon immediate operation ; accordingly, on the 21st of January, in the presence of Medical Inspector Bloodgood, and other members of my corps, and assisted by Surgeons Jones and Ayres and Passed Assistant Surgeons Anderson, DuBose, Drake, and Wilson, I removed, en masse, the tumour, together with the entire superior maxilla, and a portion of the malar bone—the patient, in the semi-recumbent posi¬ tion, being chloroformed by Dr. DuBose ; the chloroform was immedi¬ ately preceded by the administration of one ounce of whiskey and a half¬ grain of sulphate of morphia. The incisions were as follows : Trans-facial below edge of orbit from body of malar bone to inner angle of eye, joined by a perpendicular cut following the line of the nose, and stopping just short of the gingivo-labial fold; the latter not being divided until later in the operation in order to avoid hemorrhage into the mouth ; the nose and inner flap were then separated from their attachments to the bone, and the periosteum from the orbital plate sufficiently to clear the edge of the orbit and the nasal process : an attempt was now made to dissect the integuments of the cheek from the tumour, but was so seriously embarrassed by the tension of the tissues that the gingivo-labial fold was at once cut through, when the large flap was rapidly liberated from its attachments back to the tuberosity, laying bare the body of the tumour. The periosteum was now raised from the body of the malar bone, and the encroachments of the tumour preventing a more internal section, it was cut through, and into the orbit as far as the spheno-maxillary fissure by means of a Key’s saw and bone pliers,—from here to the angle of the eye the orbital plate was broken through by a short, broad blade, and the nasal process divided with bone pliers,—extracting two incisors, the hard palate and alveolus were cut through, close to the septum, by bone pliers, and the operation completed by seizing the tumour with the lion-jawed forceps and wrenching the entire mass from its posterior connections. The hemorrhage during the operation was comparatively trifling—no artery required ligation, and a few arterial branches were twisted. At the suggestion of Medical Inspector Bloodgood, the flaps and cavity were freely sponged with hot water with the effect to immediately stop all oozing. The patient’s pulse continued good during the operation, lie swallowed very little blood, did not choke, but seeming to fail just at the completion, an enema of brandy and beef essence was administered, and forty minims of whiskey hypodermically. Although the tumour was removed in twenty- eight minutes the cavity was allowed to remain open more than an hour, when, all oozing having ceased and the tissues being glazed over, the flaps