POLYPUS.
Polypi may be removed by various means according to the situation of the growth and the presence or absence of a pedicle.
Nasal mucous polypi may be removed after painting the region about their bases with Cocaine solution. The cold wire snare may be gently coaxed round the pedicle, and the loop tightened so as to cut through the attachment of the tumour. The galvano-cautery snare is preferable, as hemorrhage is absent and pain is slight. The point of attachment after , either method of removal should be well cauterised with the point of the hot wire to prevent the growth sprouting again, or it may be touched gently with Chromic Acid.
Sometimes there is much difficulty in getting the wire round the base or pedicle, in which case the tumour may be firmly grasped by stout forceps and twisted till the base gives way. As they are frequently multiple, several sittings are necessary, and there may be much haemor rhage, which should be controlled by the cautery; Adrenalin may be neces sary.
The medical treatment of nasal polypi is unsatisfactory, but occasionally a soft gelatiniform polypus springing from the turbinated hone may be caused to shrivel up and disintegrate by the continual use of a snuff consisting of finely powdered Tannic Acid. Parker has employed Salicylic Acid with advantage in the same way, and powdered Sulphate of Zinc or Alum is sometimes successful. The spray of strong Alcohol may be used, or various astringent solutions may be applied with a large camel's-hair brush, or the same solutions may be injected by the hypo dermic needle into the growth, or, in more dilute solution, they may be used as nasal douches. Glycerin of Carbolic Acid and Solution of Per chloride of Iron may be thus used. Ethylate of Sodium Solution may be efficacious if brushed over soft or even moderately fibrous polypi. Chromic Acid fused upon a roughened probe is the best of all agents for touching small polypi.
Though these methods of dealing with nasal polypi must be considered as anything but satisfactory in the first instance, especially where the growths are within easy reach of the snare or forceps, nevertheless they are of great value as auxiliaries to the surgical measures.
Firm fibrous polypi generally spring from the roof of the naso-pharynx; their removal is attended with severe haemorrhage and the approach is often difficult, sometimes requiring division of the soft and sometimes of the hard palate, with plugging of the pharynx after a preliminary laryn gotomy.
After applying Cocaine to the nose and lip, Baracz makes an incision through the lip immediately to one side of the middle line, and carries it up through the fleshy part of the nose on one side of the septum as far as the nasal bone. If the growth be very large, he cuts the nasal bone and turns it aside with the flap of the skin, which, upon being forcibly retracted, permits of the nasal aperture being somewhat enlarged by bone forceps. Upon introducing one finger into the nostril and another behind the soft palate, the polypus can be enucleated by the finger-nail. He states that by this plan of operating, the entire nasal cavity, as far as the base of the skull, can be reached as effectually as in the more formidable operation of Langenbeck. There is little hzemorrhage, and upon bringing the edges of the wound accurately together, only a linear scar remains.
Firm fibro-sarcomatous polypi, when exposed by any of these methods, should be removed by the ecraseur or raspatory, and the base should be thoroughly destroyed by the cautery before plugging of the naso-pharynx with gauze.
Uterine polypi may be removed by the ligature, torsion, snare, ecraseur, galvano-cautery wire or excision by knife, according to the peculiar con ditions maintaining in each case. Small polypi can generally be easily twisted off by grasping the pedicle in a pair of stout ovum forceps. When large, firm polypi grow from the ceiling of the uterus, rough or strong traction upon their pellicles, especially if these are short, may cause a portion of the uterus to become inverted, and this might be included in the ecraseur if the surgeon was not upon his guard. The best procedure is to dilate the cervix under strict antiseptic precautions with a series of graduated metal dilators, and apply the wire of the galvano-cautery to the pedicle of the tumour, after which the uterus may be curetted and its cavity firmly packed with sterile gauze.