The advantages of the Trendelenburg posture during all operations involving directly or indirectly the cavities of the mouth, nose, and the trachea : with a report of two cases of epithelioma and sarcoma of the tonsil / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: The advantages of the Trendelenburg posture during all operations involving directly or indirectly the cavities of the mouth, nose, and the trachea : with a report of two cases of epithelioma and sarcoma of the tonsil / by W.W. Keen. 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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    In illustration of the value of the Trendelenburg posi- tion, I beg to report the following two cases: Case I.—Primary Epithelioma of the Tonsil; Removal in the Trendelenburg Position; no Return at the End of a Year.—J. G., aged forty-eight years, was kindly referred to me at the Jefferson Hospital by Dr. Muldridge, of Manayunk, on March 26, 1896. His family and personal history are excellent; no malignant dis- ease has occurred in any relative. On January 20, 1896, he was seized with decided rigidity on the left side of the jaw, so that he could scarcely open his mouth. There was also swelling and tenderness at the angle of the jaw, which gradually subsided. About a month ago he noticed an enlargement of the left tonsil, which caused difficulty in swallowing. His voice was weak and hoarse and his throat dry and irritated. Increase in the size of the growth was steady, and was attended with dull, deep-seated pain. Eight days before his admission I removed a portion of the tonsil and referred it to Dr. Kyle for examination, who re- ported that while the upper layers, on account of the ulceration, showed appearances which might be simply inflammatory or pos- sibly sarcomatous, the deeper layers showed undoubtedly that it was an epithelioma. On admission the tonsil was found to project nearly as far as the uvula and showed an irregular nodulated growth on its sur- face. His temperature was normal and general health excellent. Urine negative. Operation March 25, 1896. I first made the external inci- sion of Cheever from the lobule of the left ear downward and forward to the hyoid bone. The parts were then dissected till I reached a depth at which the finger perceived the tonsil. In order to get better access, however, to the tonsil, I split the cheek from the angle of the mouth to the masseter muscle. I was then able to dissect out the entire growth very thoroughly without the least anxiety about the vessels as my two fingers in the external wound protected the vessels and separated them from the tonsil. The mucous membrane inside the mouth was then closed by a few silk stitches and both external wounds closed. On the seventh and ninth days all the stitches were removed. His tem- perature was normal till the tenth day, when a slight accumula- tion of serum in the wound in the neck caused the temperature