After-treatment. It is well to check the hæmorrhage without the use of plugging. Some antiseptic powder—europhen, xeroform, formidine, aristol, &c.—if lightly insufflated over the wounded area, will assist in the formation of a protective scab. This should not be disturbed for some days, during which the nose is made comfortable by some menthol and boric ointment, or a paroleine spray. When the scab begins to break down its removal is assisted by warm alkaline lotions (see [p. 579]). The stump may require a few applications of nitrate of silver or other silver salt. There is no danger in this operation. Healing, as in other intranasal operations, takes from three to six weeks.
Amputation of the lower margin. Indications. This is not infrequently necessary when there is a general hypertrophy—as in the compensatory hypertrophy of septal scoliosis ([Fig. 310])—or when the whole lower and outer margin is occupied by papillary hypertrophies ([Fig. 289]).
Operation. The operation can be carried out under the local application of cocaine and adrenalin, but is frequently performed as part of some other operation under a general anæsthesia.
The steps have to be varied according to the degree and extent of the hypertrophic tissue requiring removal. When this is principally along the lower border of the turbinal it can be removed with one cut of a stout pair of nasal scissors (Fig. 290). Under good illumination a blade is insinuated along the concavity, while the other passes between the convexity and the septum. Care should be taken that the direction of the scissors is parallel to the axis of the turbinal body, and that the cut embraces only that portion of the lower area to be removed. The severed portion should be quickly seized with a pair of punch-forceps and lifted out, or the patient, if only under local anæsthesia, may be requested to blow it forward into a tray. Otherwise it is apt to become obscured in the outpouring of blood, and, if the patient is unconscious, to be sucked backwards out of sight. If, as not infrequently happens, the lower margin remains attached at its posterior extremity, a wire snare is threaded along over it so as to cut this through. When the papillary hypertrophy is more diffuse it is apt to be concealed in the concavity of the turbinal. From this hiding-place it can be partially dislodged with a probe and then cut off with a snare.
The after-treatment is similar to that for removal of the anterior end.
Removal of the posterior end. Indications. The posterior extremity of the inferior turbinal is very subject to a moriform hypertrophy, and some delicacy and skill are required in removing it.
Operation. The interior of the nose on the affected side should be treated with a weak solution of cocaine and adrenalin. The most disagreeable part of the operation is the introduction of the operator’s finger into the post-nasal space. Hence the fauces should be freely sprayed with a 5% solution of cocaine. This will deaden painful sensation, but it will not prevent the discomfort nor the nausea often induced.
It is well to avoid as much as possible the direct application of cocaine or adrenalin to the moriform hypertrophy itself, for it is an extremely vascular growth, and if much contracted it is more difficult to ensnare.