- Email: [email protected]
Excision and restoration of upper lip
PROGRESS IN SURGERY Selections from Recent Literature
SHEDDEN, ~VILLIAM M., Boston. The surgica1 treatment of epitheIioma from the Massachusetts Genera1 and the Cancer Commission of University. Boston AI. G S. J., Feb. cscvi, 262.
results of of the lip HospitaI Harvard 17, 1927,
From this study Shedden concludes: I. The “ radica1” neck dissection as described will give three-year cures in 76 per cent of the cases. dissection wiI1 give 42 2. This “ radicaI” per cent of cures e\-en when cancer is present in the glands. 3. Aletastatic cervica1 gland cancer can exist in absence of paIpabIe glands. PaIpabIe gIands do not necessariIy mean cancer. 4. It is most necessary to excise chronic uIcers and tumors of the lip, if there is a possibilitj of cancer, and to have a microscopica examination of the tissue excised. 5. Separation of the tumors into pathoIogica1 groups depending on reIative malignancy is apparentIy of distinct vaIue as regards prognosis and choice of operation. 6. The delay between onset and admission to the hospital, and that between the visit to the doctor and admission to the hospita1 is too Iong. -. The position of the growth on the Iip should determine whether the neck dissection is to be biIatera1 or unilatera1. 8. llore neck dissections couId be done on the otherwise inoperable if sufficient narcosis and focal anesthesia were employed. g. Syphilis is not commonIy seen with cancer of the Iip and its presence should not delay adequate operative procedures. IO. Heredity pIays a minor part in this disease. PICKERILL, H. P., New Zealand. Excision and restoration of upper Iip. Brit. J. Surg., Jan., 1927, xiv, 536. PickeriII has reported instances, in a previous communication, in young men, for whom considerabie restorations of Iost portions of the face had been undertaken by means of tubegrafts, incIuding the doubIe tube-graft Asp, which he originated in rgr 8. He now shows b?
a case report that such grafts are also successfu1 in older men. A man, aged sixty&e, was admitted with a Iarge fungating growth of the upper lip about the size of a hen’s egg. PickeriII excised the upper Iip under IocaI anesthesia. Six weeks restoration was commenced. later plastic The first stage was to form the new Iip from two ffaps, one from the chest for the inner surface and one from the scaIp for the outer surface. The scalp Asp is superimposed on the chest flap, united, and aIlowed to lie alongside the left ear for a fortnight. The lower end is then divided, swung across, and inserted in the prepared bed on the right and upper borders of the excision wound. At the next stage the graft is divided and the proxima1 end inserted into the left side of the excision wound. The scalp tube is opened out and replaced. The patient, of course, was enabIed rapidIy to grow a moustache. A point of interest Iies in the escehent substitute chest skin makes for mucous membrane when transferred by doubIe tube haps. The extraordinary thing is that if the same skin were grafted into the same area as a free graft, it wouId remain white and wouIcl never take on the appearance of mucous membrane. FARR, ROBERT EMMETT, Minneapolis. Some shortcomings in the surgery of cleft lip and palate with suggestions for meeting them. Minnesota Aded., Feb., 1927, x, 70. The foIlowing innovations are suggested: I. The Brophy wiring may be done in two stages. 2. Postoperative manua1 stretching of the lip will relieve tension, increase redundancy and prevent its thinning out. 3. The nasal septum may be divided at its base to aIfow proper eIevation of the nasal tip. 4 The proIabia may be used as a prolongation of the coIumeIIa rather than a portion of the newIy constructed Iip. 5. Lip tension shouId be more often relieved by making incisions along the “laughing wrinkIe.” 6. CIeft Iip may be cIosed in two stages. 395
SHEDDEN, ~VILLIAM M., Boston. The surgica1 treatment of epitheIioma from the Massachusetts Genera1 and the Cancer Commission of University. Boston AI. G S. J., Feb. cscvi, 262.
results of of the lip HospitaI Harvard 17, 1927,
From this study Shedden concludes: I. The “ radica1” neck dissection as described will give three-year cures in 76 per cent of the cases. dissection wiI1 give 42 2. This “ radicaI” per cent of cures e\-en when cancer is present in the glands. 3. Aletastatic cervica1 gland cancer can exist in absence of paIpabIe glands. PaIpabIe gIands do not necessariIy mean cancer. 4. It is most necessary to excise chronic uIcers and tumors of the lip, if there is a possibilitj of cancer, and to have a microscopica examination of the tissue excised. 5. Separation of the tumors into pathoIogica1 groups depending on reIative malignancy is apparentIy of distinct vaIue as regards prognosis and choice of operation. 6. The delay between onset and admission to the hospital, and that between the visit to the doctor and admission to the hospita1 is too Iong. -. The position of the growth on the Iip should determine whether the neck dissection is to be biIatera1 or unilatera1. 8. llore neck dissections couId be done on the otherwise inoperable if sufficient narcosis and focal anesthesia were employed. g. Syphilis is not commonIy seen with cancer of the Iip and its presence should not delay adequate operative procedures. IO. Heredity pIays a minor part in this disease. PICKERILL, H. P., New Zealand. Excision and restoration of upper Iip. Brit. J. Surg., Jan., 1927, xiv, 536. PickeriII has reported instances, in a previous communication, in young men, for whom considerabie restorations of Iost portions of the face had been undertaken by means of tubegrafts, incIuding the doubIe tube-graft Asp, which he originated in rgr 8. He now shows b?
a case report that such grafts are also successfu1 in older men. A man, aged sixty&e, was admitted with a Iarge fungating growth of the upper lip about the size of a hen’s egg. PickeriII excised the upper Iip under IocaI anesthesia. Six weeks restoration was commenced. later plastic The first stage was to form the new Iip from two ffaps, one from the chest for the inner surface and one from the scaIp for the outer surface. The scalp Asp is superimposed on the chest flap, united, and aIlowed to lie alongside the left ear for a fortnight. The lower end is then divided, swung across, and inserted in the prepared bed on the right and upper borders of the excision wound. At the next stage the graft is divided and the proxima1 end inserted into the left side of the excision wound. The scalp tube is opened out and replaced. The patient, of course, was enabIed rapidIy to grow a moustache. A point of interest Iies in the escehent substitute chest skin makes for mucous membrane when transferred by doubIe tube haps. The extraordinary thing is that if the same skin were grafted into the same area as a free graft, it wouId remain white and wouIcl never take on the appearance of mucous membrane. FARR, ROBERT EMMETT, Minneapolis. Some shortcomings in the surgery of cleft lip and palate with suggestions for meeting them. Minnesota Aded., Feb., 1927, x, 70. The foIlowing innovations are suggested: I. The Brophy wiring may be done in two stages. 2. Postoperative manua1 stretching of the lip will relieve tension, increase redundancy and prevent its thinning out. 3. The nasal septum may be divided at its base to aIfow proper eIevation of the nasal tip. 4 The proIabia may be used as a prolongation of the coIumeIIa rather than a portion of the newIy constructed Iip. 5. Lip tension shouId be more often relieved by making incisions along the “laughing wrinkIe.” 6. CIeft Iip may be cIosed in two stages. 395