TREATMENT.—It has been maintained (Lassus) that the hypertrophy can be overcome by systematic compression of the tongue, by leeching the tongue, bandaging or strapping it, and forcibly maintaining it in the mouth by suitable retentive appliances. While it has been admitted that this plan may prove successful in cases of moderate enlargement of but few years' duration and unaccompanied with change in the shape of the lower jaw, the experience of more recent observers has been recorded as unfavorable, at least in pronounced cases. Clanny30 succeeded in this way with a child five years of age whose tongue protruded three inches. This plan is said to be very painful and irritating. It requires close watching on account of the difficulty of respiration which may ensue from thus blocking up the pharynx. It has been advised as a useful and sometimes an essential preliminary (Syme) to a radical procedure consisting in the excision of a V-shaped segment. This latter operation (Boyer) has been successfully performed by Howe, Harris, Humphry, Syme, and others. Frederici31 extended the incisions to the very base of the tongue. It has been performed both with knife and with scissors, the cut surfaces being united with sutures after ligation or torsion of the bleeding vessels. Re-enlargement ensued in one of Syme's cases operated upon in this way,32 and likewise in a case of Gies,33 requiring subsequent excision of the exuberant portions. Operations with the ligature, though sometimes successful (Fergusson,34 Hodgson35), may be followed by fatal septicæmia during the slough (Liston36), or, failing to strangulate the tongue sufficiently, may require the application of the knife, after all, to affect the separation (Harris37).
30 Edinb. Med. and Surg. Journ., 1805, vol. i., cited by Clarke.
31 Arch. gén. de Méd., 1844; Edinb. Med. and Surg. Journ., p. 528, vol. lxiv., 1845.
32 Edinb. Med. Journ., 1857, vol. ii. p. 1057.
33 Arch. klin. Chir., 1873, p. 640.
34 Practical Surgery, London, 5th ed., p. 518.
35 Trans. Med.-Chir. Soc. London, 1858, p. 129.
36 Elements of Surgery, p. 334, Philada., 1842.
37 Am. Journ. Med. Sci., vol. vii. p. 17.
Excision with the incandescent loop of the galvano-cautery seems to be the most suitable procedure. Valerani38 operated in this manner without the loss of a drop of blood upon a congenital macroglossia in a child seven months of age. Maas39 operated in this way on a child two months of age. Fairlie Clarke, who removed a congenital macroglossia with the écraseur in a child five months of age, recommends operation before dentition begins40—an opinion which appears to be justified by the belief that the pressure of the teeth contributes to the subsequent rapid enlargement of the organ. Nevertheless, the operation may be undertaken at any age. Several of those already cited were performed upon adults, and Stephen O'Sullivan41 excised the hypertrophied tongue of a female sixty-five years of age.