CANCER OF THE TONGUE.—Small superficial patches of malignant growth which have supervened upon leukoplakia, especially when caustics have been employed in its treatment, should be excised (after oral sepsis has been met) by pulling the organ forwards with a ligature inserted into its 9 tit) and cutting out a V-shaped or elliptical piece of tissue containing the grow di, after w WI the edges are to be secured with suture, and, as in all o.iigue operations, local antiseptic mouth washes must be continuously used.
\\ hen the grow th is situated in the anterior part of the tongue and has invoIN cd the deeper parts, but has not extended beyond the middle line of the organ or invaded the floor of the mouth, Whitehead's operation meets all requirements. Oral antiseptics having been used for sonic days, the mouth is gagged and a ligature is inserted well behind the tip of the tongue on each side, su as to enable the organ to be pulled forwards. 'llie tongue is next split along the median line, its attachment to the floor of t he and palate cut through with scissors, and the half of the organ containing the growth cut across well behind the tumour, after ligature of the lingual artery.
Where the growth involves the entire organ without invading the floor of the mouth, this may be completely removed by the last-mentioned operation, each hail of the tongue being divided separately.
Where the tissues in the flour of the mouth have been invaded, these with the diseased tongue and all the affected lymphatic glands, with a portion of the lower jaw, have been successfully removed. The operation is varied to the requirements of each case, the most frequently employed being that of Svinu, which consists of a median incision through the middle of the lower lip and extended to the hyoid bone, the symphysis being after wards divided by saw and the diseased tissue dissected out and removed en mass'. SUIIICtillICS a laryngotomy is essential. Butlin insists upon the routine removal of all the glands in the anterior triangle of the neck by a second operation after the removal of the cancerous tongue by tile mouth; he never divides the jaw and always performs a preliminary laryngotomy. Operative measures in the hands of Butlin show that
57 patients were cured Out of 200, and remained free from recurrence of the disease for periods of from 3 to 22 years after the operation, and so per cent. died as the result of the operation.
The alter-treatment is of importance, and since this must sometimes h•ft in the hands of the ordinary attendant his attention to the follow ing details is essential. The great danger is that of an aspiration pneu monia setting in from the secretions of the mouth finding their way down the and into the air cells. I I ence the necessity for antiseptic mouth %Noshes, the best of which is Permanganate solution, Carbolic sprays, hydrogen Peroxide, or even weak Perchloride of Mercury, the latter only to be used occasionally, \vhilst the former are employed every hour.
Feeding must be effected by milk and soups administered from a feeding cup to which a short rubber tube is attached.
The ligature attached to the stump of the tongue should be carefully fixed outside the mouth so as to prevent the stump falling backwards and causing obstruction to the admission of air to the larynx.
AxcLi< or rut, ToNsn..—Removal of the organ, to be successful, must be resorted to at a very early stage of the disease, whether the affection is carcinomatous or sarcomatous. Whilst the latter type of malignant tumour can often be removed by the mouth, the operation for removal of a cancerous tonsil can generally only be effected after reaching the growth through an incision in the neck, as in the formidable operation for cancer of the tongue, the lower jaw often requiring division.
Palliative measures will consist of gastrostomy when swallowing is impossible, and tracheotomy may be required for the relief of larnygeal obstruction. Little can otherwise be done save by the almost continuous use of antiseptic washes and sprays.