Case of osteo-sarcoma of the lower jaw, removed by James Syme.

  • Syme, James, 1799-1870.
Date:
[1828]
Catalogue details

Licence: Public Domain Mark

Credit: Case of osteo-sarcoma of the lower jaw, removed by James Syme. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The external surface of the tumour should be completely exposed before proceeding farther, since all the vessels which ought to be tied may then be tied in the first instance, and a free drain is afforded to the blood which oozes from the small branches. The mucous membrane of the mouth being next cut by a scalpel, carried from the tonsii outwards, the tumour is rendered much more moveable, and the surgeon will gene- rally be able to free the coronoid process from its muscular connections. Should he fail in doing so, he ought to cut it across with the saw or pliers, and then depressing the tumour as far as possible, open the articulation on its fore part; after which he has merely to carry his knife close to the tumour, and divide the remaining attachments. I think Dr Cusack is entitled to much praise for insisting on the propriety of opening the articulation from before, since a wound of the internal maxillary, or even the temporal is other- wise almost inevitable. Thus Mr Liston, in the case detailed in the last number of this journal, opened the joint from behind, and found it necessary to tie the common trunk of the temporal and internal maxillary,—in short, the external carotid. I do not mean to say that this proceeding was very dangerous to the pa- tient, or very difficult to so expert an operator as Mr Liston. But I think that the great object of a surgeon should be to avoid • cutting any thing which it is not necessary to cut. And I think ' that the patient in this case would hardly have suffered the se- vere secondary hemorrhage which is mentioned in the relation ireferred to, if the superficial vessels merely had been divided. It appears also that in Mr Liston's case the ascending bran- iches of the portio dura were cut, since the patient''s eyelids were ]paralysed. Now this in all probability would not have happen- ed, if the articulation had been opened from before. jP. S.—Penman is now quite well. His mouth is contracted ito nearly the natural size, and his appearance is not disagreeable. IHe is daily improving in articulation, and can already express i^is wants pretty intelligibly. He has become much stronger, land is thinking of resuming his occupation. 75, George Street, \5th August 1828. Printed by John Stark.