2. Osteomata are sometimes too large to be extracted through the natural orifice, and as they are much too hard to break up in situ, this operation is clearly indicated.
3. Malignant growths.
Fig. 318. Rouge’s Operation. First stage. The upper lip is everted and retracted by an assistant standing behind the patient’s head. The dotted line indicates the line of incision.
Operation. Standing behind the head of the patient, an assistant seizes the extremities of the upper lip between the forefinger and thumb of each hand, so as to turn it up against the nostrils and present its mucous surface. A small packet of loose gauze is placed at each corner of the mouth, to be handy for stanching any bleeding. An incision is then made across the gum, a little below the gingivo-labial fold, from the first upper molar on one side to the other (Fig. 318). This is carried right down to the bone.
With a raspatory the soft parts can be easily and rapidly separated up, so as to bring the orifice of each nasal chamber into view. With a pair of scissors curved on the flat the cartilage of the septum is next detached from the nasal maxillary spine, or the latter can be detached with a chisel and hammer (Fig. 319). The assistant is now able to pull the everted lip with the fleshy parts of the nose further up on to the face, fully exposing the pyriform orifice of the nasal chambers, with part of the anterior wall of the superior maxilla exposed on each side.
Fig. 319. Rouge’s Operation. Second stage. The soft parts are retracted.
The conditions met with are then dealt with as required. Hæmorrhage gives little trouble, and can generally be checked by pressure with strips of gauze, possibly supplemented by the use of peroxide of hydrogen. When the operation has been completed the everted lip is turned down, and falls into place, where it can be secured by a few catgut sutures.
After-treatment. Two pads of cotton-wool over the upper lip, to right and left of the nasal openings, will give relief and secure healing of the wound by first intention. The mouth should be kept as clean as possible, and cleansing measures to the nasal chambers will be required in proportion to the amount of destruction of its self-cleansing mucous membrane.