Bleeding is generally abundant at first. It can be controlled with tampons and the use of hydrogen peroxide. When the whole of the malignant growth has been removed, hæmorrhage generally stops spontaneously. Firm packing of the wound is therefore unnecessary and is best avoided. The large cavity is filled with one long strip of 1-inch ribbon gauze, which is left projecting from the nostril, and the skin incisions are carefully brought together with silkworm-gut sutures. Healing takes place by first intention. There may be a little flattening of the side of the nose, but there is no disfigurement, and a few months afterwards it is difficult to detect any trace of the operation. The strip of gauze is removed in 24 to 48 hours, and simple intranasal cleansing measures are then instituted (see [p. 579]).
ROUGE’S OPERATION (SUBLABIAL RHINOTOMY)
No special instruments are required for this operation. Full illumination—with a Clar’s mirror or frontal search-light (see [p. 571])—is particularly necessary.
In addition to the usual preparations, the mouth, teeth, and gums should be purified as much as possible beforehand.
General anæsthesia, preferably with chloroform, is required.
Indications. With the progress of rhinology the occasions for invading the nasal chambers otherwise than by the natural orifices have steadily diminished. Rouge’s operation was formerly employed in dealing with deformities of the septum, in the treatment of ozœna, in lupus of the nose, for the removal of simple mucous polypi, in operations on naso-pharyngeal fibromata, or as a simple method of exploration. In all these circumstances it is now uncalled for, as we are possessed of simpler, safer, and more effective methods.
In more modern times it has been advocated as a route of approach to the accessory cavities of the nose by some authors, but this proposition has not met with general support.
The chief indications for Rouge’s operation are as follows:—
1. Very large sequestra. The majority of syphilitic sequestra can be removed through the natural orifice. In some cases they can be broken up after being mobilized and then removed through the nostrils. If still impossible of extraction Rouge’s operation is indicated.