Statistical report : 1932 / Mount Vernon Hospital.

  • Mount Vernon Hospital (Northwood, London, England)
Date:
1932
Catalogue details

Licence: Public Domain Mark

Credit: Statistical report : 1932 / Mount Vernon Hospital. Source: Wellcome Collection.

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    sometimes blood-stained ; any unusual amount of bleeding is significant, especially in an elderly patient who has never had previous trouble with his antrum. No attention should be paid to a negative result. It is better to open up a healthy antrum through the incisor fossa than to overlook a growth while it is still intrinsic. Sometimes the general inflammation may even now over-shadow the growth, and again a biopsy may be indefinite. This places a very serious responsibility on the surgeon, and until an exact test for cancer is available, many of these cases, a larger proportion than is generally recognised except by those who are working in cancer clinics, must be treated while in such an embryonic stage as to be labelled of doubtful malignancy : otherwise some of them will develop metastases in the liver, lungs, or any part of the body, and lives may be lost because the doctor is afraid to state a diagnosis which instinctively he knows to be correct and the patient unwilling to face the position because of this hesitation. Treatment.—There are three main methods, namely Surgery, Diathermy and Irradiation. The purpose of this report is to emphasise that experience has accumulated in the last ten years to show that these growths are so variable in type that no surgeon can undertake to treat them properly unless he has all three methods at his disposal. To remove a rapidly growing round cell sarcoma by surgery alone is a useless and dangerous treatment. And one can go much further and say that those of us who have had sufficient experience of “upper jaws” have come to the conclusion that surgery and, to a less extent, diathermy are by themselves unsatisfactory because of the high ratio of local recurrences. We prefer not to balance these three treatments one against the other, but to employ them all in different combinations according to the nature of the case. And it must be admitted that the main point of this thesis is to emphasise that growths in the jaw cannot be safely treated without radiation and in most cases patients must go to special cancer clinics for the purpose. For years past the details of our treatment have been constantly modified, but a fairly constant method has gradually been evolved :— (1) Growth suspected :—A short course of X-rays is given over three or four days. This amounts to about one-third of a full course of high voltage X-rays and usually causes a distinct shrinking of the neoplasm, rarely of inflammatory conditions. (2) Biopsy.—When a definite diagnosis is obtained the decision as to treatment is much easier and depends on the type. (3) If the tumour is a round celled sarcoma or an anaplastic carcinoma cutting is avoided if possible, as the best treatment seems to be high-voltage X-rays with or with¬ out radium (surface or bomb), or interstitial needling in some cases. If surface irradi¬ ation alone is advised the patient must be sent to an institution which possesses a high current X-ray apparatus and a large amount of radium. In all the experimental centres of the world there is a growing tendency to use higher voltage machines and larger doses of radium for surface treatments. (4) If the tumour proves to be a spindle celled or fibro-sarcoma or a squamous celled carcinoma with cell nests or adeno-carcinoma or endothelioma. Surgery and Diathermy are indispensable, because it is at present very difficult to deliver an adequate dose to such growths which are so deeply situated by surface treatment alone. It has been found that complete removal of the upper jaw is no longer necessary or advisable. As most of the growths are complicated by sepsis the first essential is to provide adequate drainage and this can be obtained by removal of the hard palate and alveolus on the affected side or in very localised tumours by making a free opening through the incisor fossa. Such openings also give free access to the growth, whether situated in the antrum, in the nasal fossa or in the other accessory sinuses, such as the ethmoids or sphenoid, but not to the fontal sinus. The visible part of the tumour can easily be removed through
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