Chronic suppurative dacryocystitis : and its radical treatment / by Fred. T. Tooke.

  • Tooke, Fred T.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Chronic suppurative dacryocystitis : and its radical treatment / by Fred. T. Tooke. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    Tho sac is now sf izcd by a pair of fixation forceps and drawn gently forward, while a careful diseecliou with a pair of small, sharp-pointed, curved scissors la begun beneath the sac. A method which I have found to be of decided value and which I always employ at this juncture is, when once I have separated the sac at on6 point from the underlying fossa, to introduce a tenotomy hook under the sac. I am now able to follow the sac downwards to the nasal duct and upwards to the puncta, always cutting beneath the heel of my hook without fear of wounding the sac above. V^ery little subsequent dis- section of the overlying connective tissue is necessary, and the sac is severed as close to the puncta above and to the nasal duct below as is possible. When the sac has been removed a specially-devised curette is intro- duced into the nasal duct, which is quite denuded of its mucous surface; this procedure allows subsequent drainage of the cavity for one or two days after the operation, and assures the operator of complete stenosis by the formation of cicatricial tissue ab* ut the duct, rendering any subsequent infection through tlie nose impossible. The wound cavity formerly occupied by the sac is thoroughly irrigated with a warm bichloride solution, and the edges of the skin wound are brought carefully together by a few silk sutures. A. small firm roll of absorbent cotton, about the thickness and half the length of one's little finger, is placed over the line of incision and a compress dressing applied. This should be left undisturbed for three days ; the sutures may be removed three or four days later. The advantages of this procedure are briefly as follows : The operation is not dangerous; a very small wound is necessary, allowing one all the space he requires to carry out a complete dissection. As very little disturbance takes place in the surrounding tissue, there is no likeli- hood of producing secondary complications, as injury to the ethmoid cells or periostitis. The operation is a complete one, the sac being removed from the canaliculi above to the nasal duct below, and the mucous membrane lining the duct being completely curetted away, no secreting surface remains; a sense of absolute security from future infection from this source is thus afforded both the patient and the surgeon. From a cosmetic standpoint it is all that can be desired; the very small incision is later hardly more noticeable than one of the ordinary lines of the face. The objection that after excision of the sac tears are still secreted, and that epiphora continues, does not hold. Of the sixteen cases to which I have referred an extirpa- tion of the lachrymal sac after Axenfeld's procedure has been performed eleven times with uniformly satisfactory results. It is difficult to explain exactly how the lachiymal gland adapts itself to the new conditions, when once the sac has been removed. We know from actual experience that when the source of infection has been removed irri- tation of the conjunctiva is allayed, and that reflex secre-