1. By the knife. If in the apex, by a V-shaped incision; if in the lateral regions, by a bold free incision with a probe-pointed bistoury round the tumour.
2. By ligature, drawn as tightly as possible, and, if the portion included be large, in successive portions.
3. By the écraseur.
Mr. Furneaux Jordan has removed the whole tongue with success by means of two écraseurs worked at the same time.[117]
4. By the galvano-caustic wire.
5. The author has in nine cases removed the affected half of the tongue by means of the thermo-cautery, first splitting it in the middle line and then cutting through the base with a curved platinum knife at a low red heat. In one only was there any trouble from hæmorrhage, and all made good recoveries.
Mr. Barwell has recorded (Lancet, 1879, vol. i.) an easy, safe, and comparatively painless mode of removing the tongue by écraseurs.
Mr. Walter Whitehead,[118] of Manchester, has had a very large experience of an operation devised by himself, in which, after pulling the tongue well forward by a string previously introduced near its apex, and the mouth being held open by a gag, he detaches the organ from jaw and fauces by successive short snips with scissors, and then in same manner divides the muscles, tying or twisting the vessels as they bleed. His success has been very great by this method, though others who have tried it have sometimes found bleeding troublesome.
It is comparatively seldom now necessary to split the jaw and perform Syme's operation, and in all operations on the tongue the thermocautory (Paquelin's) is of great use.
Regnoli's method[119] may deserve a brief notice. A semilunar incision along the base of the jaw, from one angle to the other, detaches the muscles and soft structures, and is thrown down; the tongue is then drawn through the opening, and can be freely dealt with either by knife or ligature. After removal the flap is replaced.