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Cancer of the mouth: The results of treatment by operation and radiation
New Series, Von. I, No. 4
Progress in Surgery
cubic centimeters (approximateIy 5 cc.) of Io per cent iodipin are injected into the antrum through the troear using a smalI rubber buIb such as an ear syringe. The exact amount gotten into the antrum cannot be determined and is unimportant if the patient remains upright because of the great variations in the size of the antrum. Roentgenograms are made as soon as possible after the injection. Stereoscopic views are made in the antero-posterior and lateraI positions. For iniection into the frontaI and sphenoidaI sinuses a smaII siIver catheter is used in place of the trbcar and a simiIar technique carried out. UsuaIIy catheterization of these sinuses can be done onIy after a part of the middIe turbinate has been removed. The ethmoid sinuses cannot be injected but much can be Iearned from the course of the iodized oiI in the nose as it passes back into the nasopharynx. NormaIIy the ci!ia carry it back into the nasopharynx very rapidIy and in definiteIy estabblished currents. Sinusitis isa mucous membrane infection and not an osteomyelitis. With the subsidence of an acute infection the mucous membrane returns to normaI. In chronic sinusitis the mucous membrane is thickened. It is this thick-
ening of the lining membrane of the sinuses which gives the diagnosis of an existing sinusitis. Its presence is readiIy demonstrated by the x-ray through the use of an opaque medium such as iodized oil. Iodized oiI wiII show the amount of poIypoid degeneration and thickening of the mucous membrane of the sinuses and in that way indicate the existence of a chronic infection. It is entirely free from untoward effects when used as an opaque medium in the roentgenographic study of the paranasaI sinuses. T H E PREVENTION OF SO-CALLED BATHER'S EAR.
George B. McAuIiffe, New York. Medical Journal and Record, September 15, 1926. Bathers shouId not swalIow water whiIe swimming because swallowing opens the tubes and the water may gain entrance into the middie ear. This effect is similar to that of a faulty use of the nasal douche. When bathers come out of the water they should Iet the water drain from the nose. Blowing shouId be avoided. If bIowing the nose and swaIIowing are interdicted no ear compIication wilI occur. The only time an occIusive protector is necessary is when there is an
American J . . . . . . 1of Surgery
233
open perforation or when the skin of the canaI is irritated by the water. Rubber pIugs or wooI are the best protectors. CANCER Or THE MOUTH: THE RESULTS OF TREATMENT BY OPERATION AND RADIATION.
A Study of 376 Cases Observed at the Massachusetts GeneraI and ColIis P. Huntington MemoriaI Hospitals in the Threeyear Period, 1918-192o. Channing C. Simmons, Boston. Surgery, Gynecology and Obstetrics, September, 1926. In primary cases without clinicaI evidence of metastases, surgical treatment offers 35 per cent chances of permanent cure as against 15 per cent by radiation treatment. In primary cases with clinicaI evidence of metastases, radiation treatment offers no chance of permanent cure and radical surgicaI treatment not over 5 per cent. The degree of maIignancy varies somewhat as to the situation, cancer of the cheek and upper jaw being Iess malignant than cancer of the tongue or floor of the mouth. This is probabIy due to the fact that the papilIary type is more common in the former positions. In the early cases, comparatively little reIiance as to metastases can be placed on the presence or absence of palpable glands. A certain group of cases which may be said to have been "cured" by treatment are prone to develop a second cancer at some other point in the buccaI mucosa. The results of treatment depend more on the amount of differentiation of the ceils, as determined by the microscopic examination of the specimen, than on any other one factor. AN EXTRAPERITONEAL TRANSDIAPHRAGMATIC ROUTE FOR LOWER INTRATHORACIC SURGERY. Minas Joannides, Chicago. Annals of
Surgery, September, 1926. Joannides describes and illustrates a technic for the transdiaphragmatic extraperitonealroute for surgery of the lower intrathoracic organs. It is a very desirable procedure in chest operations where one does not want to disturb the chest waII. The distinct advantage of this procedure is the maintenance of an intact chest waif and thus no embarrassment of respiration folIows intrathoracic operations. Healing per primam occurs in the cut end of the diaphragm when the operation is done under aseptic conditions.
Progress in Surgery
cubic centimeters (approximateIy 5 cc.) of Io per cent iodipin are injected into the antrum through the troear using a smalI rubber buIb such as an ear syringe. The exact amount gotten into the antrum cannot be determined and is unimportant if the patient remains upright because of the great variations in the size of the antrum. Roentgenograms are made as soon as possible after the injection. Stereoscopic views are made in the antero-posterior and lateraI positions. For iniection into the frontaI and sphenoidaI sinuses a smaII siIver catheter is used in place of the trbcar and a simiIar technique carried out. UsuaIIy catheterization of these sinuses can be done onIy after a part of the middIe turbinate has been removed. The ethmoid sinuses cannot be injected but much can be Iearned from the course of the iodized oiI in the nose as it passes back into the nasopharynx. NormaIIy the ci!ia carry it back into the nasopharynx very rapidIy and in definiteIy estabblished currents. Sinusitis isa mucous membrane infection and not an osteomyelitis. With the subsidence of an acute infection the mucous membrane returns to normaI. In chronic sinusitis the mucous membrane is thickened. It is this thick-
ening of the lining membrane of the sinuses which gives the diagnosis of an existing sinusitis. Its presence is readiIy demonstrated by the x-ray through the use of an opaque medium such as iodized oil. Iodized oiI wiII show the amount of poIypoid degeneration and thickening of the mucous membrane of the sinuses and in that way indicate the existence of a chronic infection. It is entirely free from untoward effects when used as an opaque medium in the roentgenographic study of the paranasaI sinuses. T H E PREVENTION OF SO-CALLED BATHER'S EAR.
George B. McAuIiffe, New York. Medical Journal and Record, September 15, 1926. Bathers shouId not swalIow water whiIe swimming because swallowing opens the tubes and the water may gain entrance into the middie ear. This effect is similar to that of a faulty use of the nasal douche. When bathers come out of the water they should Iet the water drain from the nose. Blowing shouId be avoided. If bIowing the nose and swaIIowing are interdicted no ear compIication wilI occur. The only time an occIusive protector is necessary is when there is an
American J . . . . . . 1of Surgery
233
open perforation or when the skin of the canaI is irritated by the water. Rubber pIugs or wooI are the best protectors. CANCER Or THE MOUTH: THE RESULTS OF TREATMENT BY OPERATION AND RADIATION.
A Study of 376 Cases Observed at the Massachusetts GeneraI and ColIis P. Huntington MemoriaI Hospitals in the Threeyear Period, 1918-192o. Channing C. Simmons, Boston. Surgery, Gynecology and Obstetrics, September, 1926. In primary cases without clinicaI evidence of metastases, surgical treatment offers 35 per cent chances of permanent cure as against 15 per cent by radiation treatment. In primary cases with clinicaI evidence of metastases, radiation treatment offers no chance of permanent cure and radical surgicaI treatment not over 5 per cent. The degree of maIignancy varies somewhat as to the situation, cancer of the cheek and upper jaw being Iess malignant than cancer of the tongue or floor of the mouth. This is probabIy due to the fact that the papilIary type is more common in the former positions. In the early cases, comparatively little reIiance as to metastases can be placed on the presence or absence of palpable glands. A certain group of cases which may be said to have been "cured" by treatment are prone to develop a second cancer at some other point in the buccaI mucosa. The results of treatment depend more on the amount of differentiation of the ceils, as determined by the microscopic examination of the specimen, than on any other one factor. AN EXTRAPERITONEAL TRANSDIAPHRAGMATIC ROUTE FOR LOWER INTRATHORACIC SURGERY. Minas Joannides, Chicago. Annals of
Surgery, September, 1926. Joannides describes and illustrates a technic for the transdiaphragmatic extraperitonealroute for surgery of the lower intrathoracic organs. It is a very desirable procedure in chest operations where one does not want to disturb the chest waII. The distinct advantage of this procedure is the maintenance of an intact chest waif and thus no embarrassment of respiration folIows intrathoracic operations. Healing per primam occurs in the cut end of the diaphragm when the operation is done under aseptic conditions.