adhesion between the septum nasi and lower turbinated bone

1
207 margin of the orbit. The flap was dissected up, and the tumour, after a very few touches of the knife, squeezed out from the cheek. A tooth was then removed in front, and the saw car- ried upwards through the hard palate, and transversely below the orbit, cutting through a portion of the malar bone, together with the superior maxilla. Next the cutting pliers were used freely, and the mass removed piecemeal. Some sof.- diseased tissue remaining behind was cut off with the curved scissors. The bleeding, free as usual in these cases at first, ceased speedily of its own accord. The wound corresponding to the division of the upper lip was brought into apposition by two hare lip pins, the remainder by interrupted sutures. Very little dis- figurement resulted from the operation. During the proceedings on the mouth, the effect of the chloroform was kept up very successfully by Dr. Sansom, by means of an india-rubber tube introduced through the disengaged nostril. 7th.-The wound, kept covered with water-dressing, is rapidly uniting; the mouth is washed out frequently with myrrh-and tannin gargle; she seems to suffer little, and takes liquid food well The pins removed from the lip. 9th.-The sutures removed; the wound almost entirely healed. 17th.-Union of the horizontal incision delayed bv the formation of a small superficial abscess beneath it, which has been opened, and has refilled several times in succession. The lower eyelid appears slightly aedematous. 27th.-The incision healed. The wound inside the mouth is granulating up, and a very slightly perceptible falling-in of the cheek remains. She takes solid food without difficulty. May 5th.-Discharged. July 16th.-The patient presented herself for examination to-day. There has been no return of the growth. The de formity is barely noticeable. The excavation is for the most part filled up, and a slight depression in the roof of the mouth, with a small, irregular aperture in the palate, alone mark the site of the operation. Some oedema of the right lower eyelid remains. The softer part of the disease appeared, on microscopical examination, to consist mainly of a fibro granular matrix, con- taining numerous corpuscles, round, regular, of uniform size, granular, and with no appearance of nuclei. The much firmer tumour of the cheek contained corpuscles of a similar cha racter, with a larger proportion of the fibrous element. GUY’S HOSPITAL. CYST IN THE ANTRUM; PUNCTURE ON TWO OCCASIONS; CURE. (Under the care of Mr. BRYANT.) ELIZA F-, aged forty, applied with a tumour in her right eheek, of one year’s growth. It was evidently an enlargement of the antrum, and, from its globular form, appeared to be cystic. Mr. Bryant introduced an exploring trocar and canula, and drew off two ounces of the peculiar glairy fluid characteristic of these cysts. The fluid, however, subsequently returned, and after the lapse of three weeks a free opening was made above the bicuspid teeth and within the mouth, giving exit to a quantity of fluid similar to the last. The cavity was plugged with lint. Inflammation followed, and some suppuration, which has resulted in the contraction of the cyst wall, and a perfect cure. She was seen three months afterwards, and no return had taken place. ADHESION BETWEEN THE SEPTUM NASI AND LOWER TURBINATED BONE. (Under the care of Mr. BRYANT.) In a recent number of the " Guy’s Hospital Reports," Mr. Bryant has drawn attention to various diseased conditions of the nostril, which have been hitherto classed under the heading of ozæna. Ulceration of the mucous membrane of the nostril was one of them, and as a curious result of such a condition the following sh rt case may be read with interest :- A man, aged forty four, applied with an obstruction in his right nostril. He had experienced it for two ears, and it had followed a "sore nose," which had lasted for two months. Upon examination, it was clearly seen that a firm union ex- isted between the lower turbinated bone and the septum nasi. The nostril was also contracted. From the history of the case, it appeared probable that both sides of the nostril had been originally ulcerated, and that union had taken place between the granulating surfaces. Mr. Bryant denuded the parts with a bistonry, and kept them apart by lint covered with oil. This was renewed constantly during the cicatrization, and recovery has taken place, the man being now well able to breathe through the nostril. In the following case there was obliteration of both nostrils, but arising from an injury :- A man, thirty-five years of age, was admitted into King’s College Hospital in March last, his appearance being most pitiable. He had been to the gold diggings of Australia, and : whilst at work in a pit, a quantity of earth fell upon him, and smashed in the bones of the nose almost flat. This was accompanied by a terrible wonnd. The result was that the nostrils were almost wholly obliterated, and the man had to ; keep in tubes to permit of his breathing through the nose. If , removed, the nose would contract. Mr. Fergusson believed it 3 possible that at the beginning the bones might not have been sufficit’ntly elevated, and be recently tried with forceps to accomplish this. or at anv rate to so enhr!!e the nassaues as to permit of the wearing of tubes again. This, to some extent, was successful by means of the separation of the M:).d’*s of a. pair of very strong forceps in the nostril; but the ultimate success of the operation lie looked upon as very doubtful. RETENTION OF URINE FROM ADHERENT PREPUCE IN A CHILD. (Under the care of Mr. BRYANT.) H. B-, aged twenty months, was brought to Guy’s Hos. pital for retention of urine, not having passed a stream for three days, a little only passing away in drops. For three months he had experienced dimculty in micturition, ha.ving on many occasions gone two days without relief. On examination, the prepuce was found adherent to the glans. This was readily separated by means of a probe, and a quantity of retained secretion removed. All symptoms disappeared, and recovery followed. WESTMINSTER HOSPITAL. TUMOUR BENEATH THE LOWER JAW; SUCCESSFUL REMOVAL. (Under the care of Mr. HOLTHOUSE.) AN elderly female presented herself at the hospital, having a tumour situated under the lower jaw in the right mylo hyoid space. It had been present for six years, and latterly corn-’ menced to grow rapidly. It was movable, and apparently un" attached to any important structure; Mr. Holthouse therefore- determined upon its removal. On the 21st of May chloroform was given, and an incision made over the growth, which with the aid of the handle of a scalpel was readily enucleated. Al- though no vessels of importance were wounded, yet there was free bleeding. The tumour was apparently an enlarged gland, but strongly resembling an albumino-sarcomatons growth. The patient made a good recovery, and left the hospital well. A few weeks later we noticed a somewhat similar case under Mr. Erichsen’s care at University College Hospital, in the person of a young woman with a tumour in thf left mylo- hyoid region. It was attributed to enlargement of the glands in that sltuatiou from the presence of decayed teeth, and had resisted the means (chiefly iodine) employed for its absorption. The tumour was superficially situated, as large as an elongated fowl’s egg, was movable, and it’9 anterior surface courted over by a large vein. Mr. t richsen believed it might be an enlarged tuberculous gland undergoing calcareous degeneration, and so it proved on removal, under chloroform, on the 12Lh of June. In this instance also a good recovery resulted. The situation of both of these tumours was over important parts, yet, as it was comparatively superficial, the operation in each was unattended by any danger. ST. BARTHOLOMEW’S HOSPITAL. CONGENITAL CYSTIC TUMOUR IN THE LOWER JAW OF AN INFANT; REMOVAL. (Under the care of Mr. COOTE.) A CURIOUS case of congenital deformity of the lower jaw was brought to this hospital, about three months a,o, in an infant. six months old. The right half of the bone was enormously

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Page 1: ADHESION BETWEEN THE SEPTUM NASI AND LOWER TURBINATED BONE

207

margin of the orbit. The flap was dissected up, and the tumour,after a very few touches of the knife, squeezed out from thecheek. A tooth was then removed in front, and the saw car-ried upwards through the hard palate, and transversely belowthe orbit, cutting through a portion of the malar bone, togetherwith the superior maxilla. Next the cutting pliers were usedfreely, and the mass removed piecemeal. Some sof.- diseasedtissue remaining behind was cut off with the curved scissors.The bleeding, free as usual in these cases at first, ceased speedilyof its own accord. The wound corresponding to the divisionof the upper lip was brought into apposition by two hare lippins, the remainder by interrupted sutures. Very little dis-figurement resulted from the operation. During the proceedingson the mouth, the effect of the chloroform was kept up verysuccessfully by Dr. Sansom, by means of an india-rubber tubeintroduced through the disengaged nostril.7th.-The wound, kept covered with water-dressing, is

rapidly uniting; the mouth is washed out frequently withmyrrh-and tannin gargle; she seems to suffer little, and takesliquid food well The pins removed from the lip.9th.-The sutures removed; the wound almost entirely

healed.17th.-Union of the horizontal incision delayed bv the

formation of a small superficial abscess beneath it, which hasbeen opened, and has refilled several times in succession. Thelower eyelid appears slightly aedematous.27th.-The incision healed. The wound inside the mouth is

granulating up, and a very slightly perceptible falling-in of thecheek remains. She takes solid food without difficulty.May 5th.-Discharged.July 16th.-The patient presented herself for examination

to-day. There has been no return of the growth. The de

formity is barely noticeable. The excavation is for the most

part filled up, and a slight depression in the roof of the mouth,with a small, irregular aperture in the palate, alone mark thesite of the operation. Some oedema of the right lower eyelidremains.The softer part of the disease appeared, on microscopical

examination, to consist mainly of a fibro granular matrix, con-taining numerous corpuscles, round, regular, of uniform size,granular, and with no appearance of nuclei. The much firmertumour of the cheek contained corpuscles of a similar character, with a larger proportion of the fibrous element.

GUY’S HOSPITAL.

CYST IN THE ANTRUM; PUNCTURE ON TWO OCCASIONS;CURE.

(Under the care of Mr. BRYANT.)ELIZA F-, aged forty, applied with a tumour in her right

eheek, of one year’s growth. It was evidently an enlargement ofthe antrum, and, from its globular form, appeared to be cystic.Mr. Bryant introduced an exploring trocar and canula, anddrew off two ounces of the peculiar glairy fluid characteristicof these cysts. The fluid, however, subsequently returned,and after the lapse of three weeks a free opening was madeabove the bicuspid teeth and within the mouth, giving exit toa quantity of fluid similar to the last. The cavity was pluggedwith lint. Inflammation followed, and some suppuration, whichhas resulted in the contraction of the cyst wall, and a perfectcure.

She was seen three months afterwards, and no return hadtaken place.

ADHESION BETWEEN THE SEPTUM NASI AND LOWERTURBINATED BONE.

(Under the care of Mr. BRYANT.)In a recent number of the " Guy’s Hospital Reports," Mr.

Bryant has drawn attention to various diseased conditions ofthe nostril, which have been hitherto classed under the headingof ozæna. Ulceration of the mucous membrane of the nostrilwas one of them, and as a curious result of such a conditionthe following sh rt case may be read with interest :-A man, aged forty four, applied with an obstruction in his

right nostril. He had experienced it for two ears, and it hadfollowed a "sore nose," which had lasted for two months.Upon examination, it was clearly seen that a firm union ex-isted between the lower turbinated bone and the septum nasi.The nostril was also contracted.

From the history of the case, it appeared probable that bothsides of the nostril had been originally ulcerated, and thatunion had taken place between the granulating surfaces. Mr.Bryant denuded the parts with a bistonry, and kept them apartby lint covered with oil. This was renewed constantly during thecicatrization, and recovery has taken place, the man being nowwell able to breathe through the nostril.In the following case there was obliteration of both nostrils,

but arising from an injury :-A man, thirty-five years of age, was admitted into King’s

College Hospital in March last, his appearance being mostpitiable. He had been to the gold diggings of Australia, and

: whilst at work in a pit, a quantity of earth fell upon him,and smashed in the bones of the nose almost flat. This was

’ accompanied by a terrible wonnd. The result was that thenostrils were almost wholly obliterated, and the man had to

; keep in tubes to permit of his breathing through the nose. If, removed, the nose would contract. Mr. Fergusson believed it3 possible that at the beginning the bones might not have been

sufficit’ntly elevated, and be recently tried with forceps toaccomplish this. or at anv rate to so enhr!!e the nassaues as to

permit of the wearing of tubes again. This, to some extent,was successful by means of the separation of the M:).d’*s of a.

pair of very strong forceps in the nostril; but the ultimatesuccess of the operation lie looked upon as very doubtful.

RETENTION OF URINE FROM ADHERENT PREPUCE IN A CHILD.

(Under the care of Mr. BRYANT.)H. B-, aged twenty months, was brought to Guy’s Hos.

pital for retention of urine, not having passed a stream for threedays, a little only passing away in drops. For three monthshe had experienced dimculty in micturition, ha.ving on manyoccasions gone two days without relief. On examination, theprepuce was found adherent to the glans. This was readilyseparated by means of a probe, and a quantity of retainedsecretion removed. All symptoms disappeared, and recoveryfollowed.

___________

WESTMINSTER HOSPITAL.

TUMOUR BENEATH THE LOWER JAW; SUCCESSFUL

REMOVAL.

(Under the care of Mr. HOLTHOUSE.)AN elderly female presented herself at the hospital, having

a tumour situated under the lower jaw in the right mylo hyoidspace. It had been present for six years, and latterly corn-’menced to grow rapidly. It was movable, and apparently un"attached to any important structure; Mr. Holthouse therefore-determined upon its removal. On the 21st of May chloroformwas given, and an incision made over the growth, which withthe aid of the handle of a scalpel was readily enucleated. Al-though no vessels of importance were wounded, yet there wasfree bleeding. The tumour was apparently an enlarged gland,but strongly resembling an albumino-sarcomatons growth. Thepatient made a good recovery, and left the hospital well.A few weeks later we noticed a somewhat similar case

under Mr. Erichsen’s care at University College Hospital, inthe person of a young woman with a tumour in thf left mylo-hyoid region. It was attributed to enlargement of the glandsin that sltuatiou from the presence of decayed teeth, and hadresisted the means (chiefly iodine) employed for its absorption.The tumour was superficially situated, as large as an elongatedfowl’s egg, was movable, and it’9 anterior surface courted overby a large vein. Mr. t richsen believed it might be an enlargedtuberculous gland undergoing calcareous degeneration, and so itproved on removal, under chloroform, on the 12Lh of June.In this instance also a good recovery resulted.The situation of both of these tumours was over important

parts, yet, as it was comparatively superficial, the operationin each was unattended by any danger.

ST. BARTHOLOMEW’S HOSPITAL.

CONGENITAL CYSTIC TUMOUR IN THE LOWER JAW OF AN

INFANT; REMOVAL.

(Under the care of Mr. COOTE.)A CURIOUS case of congenital deformity of the lower jaw was

brought to this hospital, about three months a,o, in an infant.six months old. The right half of the bone was enormously