The inferior maxillary bone is affected with en cysted tumour and osteo-sarcoma; the former being distinguished by crepitation and the absence of pain, and treated like encysted tumour of the soft parts; the latter or osteo-sarcoma by the following opera tion: An incision ought to be made along the base of the bone, in order not to disfigure the face, when the facial artery will spring and require to be se cured; the tumour and bone are then to be divested of their soft coverings, and the latter at its symphy sis first sawn in a slight degree, and next broken across with Liston's forceps; having previously ex tracted any tooth which may interfere with the saw. The operator can then move this half of the bone outwards, divide the insertion of the pterygoideus internus from above downwards, cut across the coronoid process with the forceps, leaving the divi sion of the insertion of the temporal muscle until the operation is nearly finished. The insertion of the external pterygoid muscle is next to be divided, keeping the back of the knife towards the internal maxillary artery, and by now depressing the sym physis, the capsular ligament may be easily but carefully cut round, and the one half of the bone removed. The coronoid process may then be de tached. It is seldom necessary to remove either the condyloid or coronoid processes, but merely to saw and cut with the forceps the ramus immedi ately behind the dens sapientim. If the whole bone be diseased, the same steps are to be pursued on the opposite side, if the tnmour will admit of being divided in its middle at the symphysis menti. After the removal of the bone, all arteries are to be care fully secured, the wound approximated with stitches.
adhesive plaster, compress and bandage. The pa tient should be fed on liquids for some time, and nature left undisturbed, will repair the deficiency of bone by an exudation of callus, which will nearly remove all deformity.
Calcareous depositions are found in the submax Mary duct, which are easily extracted by an incis ion through the mucous membrane of the mouth and the duct; and when either these or any other causes prevent the escape of the saliva from this duct, the latter enlarges, forms a large pouch which occasionally becomes thickened in its coats, and con stitutes the disease named ranula. This is to be treated by removing a portion of the sac and apply ing the potassa so as to obliterate it, or following the plan of Dupuytren, which is by making a punc ture into the tumour, and inserting a small hollow cylinder of the shape of the eye stilette, with a small ellipical plate convex externally attached to each extremity of the tube, in order to prevent it from slipping either into the dilated duct, or out of it into the mouth.
The tongue is subject to tumours, to enlargement from mercury and small pox, to abscess, and to can cerous ulceration. Tumours are removed either with the knife or ligature, and if the former be pre ferred and the tumour very large, the lingual arte ries ought to be first secured, or the actual cautery applied. In enlargement of the tongue, we make free longitudinal incisions, and if they do not bleed sufficiently, perform vcnesection at the bend of the arm, administer saline cathartics and glysters, ex pose the patient to a cool atmosphere, and discon tinue the mercury if it be the cause. In abscess a free opening should be made. In cancerous ulcer ation, either the ulcerated surface or the whole tongue must be removed, with the ligature orknife; if the latter is used, the lingual arteries ought to be first secured. The ligature produces less irritation in this case than almost in any other disease. When the ulceration is trifling, a mixture of honey and water, or a weak solution of arsenic often suc ceeds; and if these fail, the nitrate of copper or sil ver, and even the actual cautery may be tried. If
any of the teeth irritate the tongue, they should be extracted. Children are occasionally born with the frenum lingua; so short that they cannot suck, in which case it is to be divided with a pair of blunt pointed scissors, directing their points towards the symphysis of the inferior maxillary bone. Tumours occasionally grow from the mucous membrane of the mouth, investing the cheeks, lips, and palate, and require to be removed by the knife. The amygdalx or tonsils frequently suppurate when at tacked with inflammation. See Article MEmerNm, Vol. XII. p. 807, and should be freely opened with a bistoury cutting towards the mesial line, to avoid any risk of wounding the important blood-vessels in the vicinity. They arc also subject to such a de gree of enlargement as to require extirpation, as they impair the voice, the breathing, and deglu tition. This operation is effected either by the knife, the cautery, or the ligature. When the knife is adopted, the operator seizes hold of the tonsil with the forceps, Fig. 9. Plate DXVI. and pulls it gently forwards and mesiad, while he carries the scalpel from above downwards, or from below upwards, by which the greater portion of the mass may be extir pated. Any bleeding is easily suppressed by styptic solutions, but if not, by the actual cautery or sponge held on the part. When the uvula is so elongated as to irritate the tongue and epiglottis, exciting coughing and a disposition to swallow, and even to interrupt respiration, it must be trimmed with forceps and scalpel or scissors.
Children are not unfrequently born with a cleft velum palati, which can only be remedied when they arrive at an age capable of appreciating the beneficial effects of the operation. The operation is termed velu•synthesis or staphyloraphy, and con sists in rendering the edges raw, and approximat ing them by means of the interrupted suture. See Dr. Stephenson's Inaugural Dissertation, and Lizars' 3natontical Plates, Part IX. The partition occa sionally extends between the two superior maxillary bones, and even the upper lip, exposing at once to view the nares and basis of the cranium. Children when thus malformed cannot suck, and are even with difficulty nourished on spoon meat. The cleft lip is named hare-lip, and should be operated on when the child is three or four months old, by rendering the edges raw, and approximating them with deli cate sewing needles, and entwining a large flat lig ature in the figure of 8 around each needle, being careful not to do it too tightly, as some degree of tumefaction must occur; a piece of lint is then to be put between the ends of the needles and the lip, and the whole gently covered with a compress and a roller. In transfixing the lip, the needle should pass as near as possible to the mucous membrane investing it, and the one near the villous part of the lip should be inserted first; the needles should be removed on the third day. When there is a double cleft, the middle portion is to be left or removed according to its magnitude; and if of such a size as is to be left, one of the fissures is to be operated on before the other, allowing two or three mouths to intervene. We thus perceive that in such cases of extensive malformation, all that can be done in very early life, is to cure the cleft lip; and the two sides of the face, or the superior maxillary bones might be slowly and gently approximated by an ap paratus resembling the chin stay: and about matu rity the cleft soft palate can be united, so that if any fissure remained in the hard, its edges might be rendered raw and approximated, or if impracti cable, a piece of sponge and silver plate, or simply a silver plate with a groove round its margin might be inserted.