The author advocates the use of a four-per-cent solution of β Eucain, in preference to all others. It is less toxic than cocain and harmless to the patient; no untoward symptoms are exhibited from its use post-operatio. Various patients complain of slight uneasiness about the epigastrium, and many speak of a peculiar weakness about the knees, but these symptoms pass away quickly.
More or less stinging is felt in the wounds made in this manner, immediately after the operations, especially about the lobule of the nose, as with blepharoplasties, but this usually subsides in less than an hour. It may persist, however, in some cases, for several hours. It is well, therefore, to acquaint the patient with this fact to avoid worry or fear.
Where severe, hot applications, dry or moist, may be used to overcome it.
More or less edema follows the employment of local anesthetics, which passes away in various lengths of time, from one to four, or even five days, according to the amount used and the site and circulation of the part operated upon.
In over ten thousand hypodermic injections of eucain the author has observed only two cases of collapse, which responded readily to the usual treatment employed in such event, and has never met with a single fatality.
Sutures.—Twisted silk sutures are to be preferred, as they do not invite sepsis, as softening catgut does, and retain the parts during the entire time required for healing, while the latter is liable to become separated by uneven absorption, allowing the wound to gape at that point and causing more or less of a cicatrix, so intolerant to patients of this class.
Dressings.—Bulky bandages are not required; they heat the parts, and look unsightly. The author employs antiseptic adhesive silk plaster for covering all external wounds, except where the hair prevents its use. Moist dressings are never indicated, except in the later treatment of infected wounds.
ANGULAR NASAL DEFORMITY
This is, perhaps, the most common of all nose deformities. The nose is overprominent about the osseous bridge, extending outward and downward, hook or hump fashion. It may be congenital or the result of external violence.
There are various methods of reducing the redundant bones and cartilage; those involving submucous excision are difficult to perform for the inexperienced operators, and the external means of reduction are advised to be followed. The resultant scar, if the skin has been properly incised and not damaged by retracting pressure, and, lastly, properly and neatly sutured, should be barely visible.