PLATE XLVII
Osteoplastic Resection of Posterior Vertebral Arches. (Urban.)
Laminectomy is practised also in Pott’s disease, with the hope of relieving pressure upon the cord, due to the deformity or to the presence of tuberculous foci. It is possible that in some of these cases an incomplete operation will serve the purpose. Sufficient should be done, however, to relieve pressure if such a measure be indicated.
When laminectomy is practised for the purpose of attacking a tumor of the spinal cord the exposure of the cord should be followed by the removal of the tumor. Some of these are so placed as to make the procedure simple, while at other times it will be exceedingly difficult, if not impracticable. If the growth has so extended as to involve the bones themselves, then the measure will be futile and should be abandoned; but an isolated tumor, either within or without the dural space, in or on the substance of the cord, can usually be removed by a process of blunt dissection. Sometimes the small wounds thus made will ooze considerably and hemorrhage may prove troublesome; it should be checked before the parts above it are closed. Pressure forceps and ligatures and the occasional use of adrenalin solution will afford the necessary means for combating bleeding.
For nearly all of these operations upon the spine the chisel and the cutting forceps will suffice. Some operators, however, prefer a small saw, like that suggested by Doyen, which has a guard that can be so set as to determine the depth to which the instrument may pass. No matter what instrument be used, great care should be taken lest it pass through and beyond the bone in such a way as to lacerate the dura or the plexus of veins outside of it.
The sacrum is rarely attacked except in connection with some of those tumors already described.
The coccyx is easily removed through a median incision, the parts around it being entirely separated and the bone thus freed removed at the joint with stout scissors or cutting forceps. The instruments used should be kept in contact with the bone and not allowed to injure the veins between it and the rectum. Such a wound should not be closed completely, as a cavity always remains, which it is better to pack and permit to heal by granulation. (See [Coccodynia].)
CHAPTER XXXIX.
THE FACE AND EXTERIOR OF THE NOSE AND MOUTH.
Monsters are born with almost complete absence of the face, which is called aprosopia. They have also been observed with double faces. Again a condition of congenital hypertrophy is known involving one or both sides. On the other hand congenital atrophy is also occasionally noted, affecting one or both sides. The former is likely to be of syphilitic origin (hereditary), in which case it will be accompanied by other indications such as corneal opacity, irregularity of teeth, or other evidences of its luetic origin.