The treatment of certain malignant growths by excision of the external carotids / by Robert H.M. Dawbarn.

  • Robert Arthur Dawbarn
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of certain malignant growths by excision of the external carotids / by Robert H.M. Dawbarn. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    entirely bloodless. The wound in the mouth was well rubbed with aristol, no packing being used; and was flushed out by fountain-syringe each two hours at first. It did well. The neck-wound healed per primam. Upon October 15th the remaining external carotid was excised with the same assistants. This proved uneventful, the work upon the vessels being completed in a half-hour. The essayist asks that it be observed that, as the end of this day's operation, a step was employed, for the first time, to which he had given much thought, namely: excising also upon both sides a portion of the inferior dental artery and nerve. This was not difficult, though he regretted that it had not been thought of and carried out at the first operation, and before resection of the diseased jaw, for then the rami, upon which the work had to be done, would have been much steadier. (See Technique for reasons and steps.)- Done upon both sides it added more than a half-hour to the time under ether. Only in one additional instance has opportunity to do this inferior dental artery excision offered, which case will be found detailed hereafter (see page 19).1 In certain other patients upon whom it would probably have been a wise step, cachexia and weakness demanded ending the operation with all possible dispatch, for otherwise a death from shock—perhaps even upon the table—was justly to be feared; and such additional lower- jaw cases have refused further cutting. But it is the essayist's opinion that the permanency of the cure in both cases upon whom this step (inferior dental) was taken may fairly be attributed in some degree to this additional help toward permanent ansemia of the bone involved. The removal at the same time of a por- tion of the inferior dental nerve was simply to render a possible recurrence in loco less painful. This patient, Callahan, left the hospital early in November. There was considerable deformity due to lack of a chin, and to asymmetry because of the missing dental arcade—that upon his right; nor could we hope for redevelopment of bone to fill the gap, as the periosteum had, of course, been sacrificed. By 1 In this second patient the inferior dental artery and nerve were attacked from behind the ramus, without entering the bone at all. The ramus, by sharp retractor, was held well out from the deeper parts, thus giving more room. By this means this work was much more quickly accomplished than in the present instance.
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