Fig. 475
Resection of inferior maxilla. (Farabeuf.)
In a few cases it may be possible by the use of stout silver wire, or some other substitute, inserted between bone ends to keep them apart and thus nearly preserve the contour of the lower part of the face; but this can be expected to succeed only when the cavity of the mouth can be completely closed, so that the wire or other material may be quickly incorporated in granulation tissue, where it is expected to remain.
When it is necessary to remove the joint end of the bone the operator should work carefully along the bone toward the joint in such a way as not to injure the facial nerve, the external maxillary artery, or Stenson’s duct. With a sharp separator it is possible to thus expose the joint, and after opening it to avulse the articular surface. In operating for necrosis the healthy periosteum should be preserved, while in the removal of cancer it should be sacrificed to the same extent as the bone itself.
The same rules apply here as above with reference to the closure of the wound and the construction of flaps; an extensive plastic operation being sometimes necessitated, as when a large portion of the lower lip, the chin and the bone are removed for extensive epithelioma. Dead spaces should be avoided, any cavity should be packed sufficiently, opportunity for drainage afforded, and the mouth cavity closed. Mouth-washes should be frequently used.
These cases should be prepared for operation by a careful cleansing of the mouth and the local use of antiseptics. During any of these operations, diseased teeth which may require it should be removed, whether they occupy the site of the operation or some other portion of the jaws. The cleaner the mouth the more prompt will be the healing process.
CHAPTER XLI.
THE RESPIRATORY PASSAGES PROPER.
MALFORMATIONS OF THE RESPIRATORY PASSAGES.
The congenital malformations of the upper respiratory passages pertain mainly to the nasal septum and the interior of the complicated nasal cavities, which are rarely symmetrically arranged, and which often differ considerably. The nasal septum is frequently deviated or warped to one side, often to an extent making one nostril too restricted for easy breathing purposes. The nostrils are occasionally seen to be abnormally retracted. Malformations of the pharynx are of rare occurrence. The soft palate is occasionally found to be more of a diaphragm than is natural, and imperforation is sometimes seen. Pharyngeal fistulas have been mentioned in connection with incomplete closure of branchial clefts. They occur more commonly on the right than on the left side, and are usually incomplete. A fistula placed in the middle line and opening into the larynx or trachea is also occasionally seen, its inner opening being generally found on the side of the pharynx and just below the tonsil. This is not necessarily a persistent remains of the thyroglossal duct, but may have a different origin. Cystic distentions not infrequently occur along these fistulous tracts. Malformations of the larynx are rare and consist mainly of narrowings or stricture formations.