An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    of the growth is usually recommended, but its utility is open to some doubt. Unfortunately there are a number of cases where this operation with the snare is impossible. The shape and broad attachment of the tumor is such at times that a wire cannot be made to encircle the growth. Electrolysis should then be tried, more with the hope of diminishing the size of the mass or altering its shape to such an extent that the snare-operation is practicable. It is sometimes only possible to remove it piecemeal. Hemorrhage does not occur with the hot snare, and is not uncontrollable with the cold wire. Tamponing the post-nasal space may be necessary, and firm pressure may be made with curved instruments against the stump. Recurrence is frequent, and a number of operations may be necessary. If the growth can be kept in check until the period of immunity is reached, the recurrence may be finally prevented, and even retrocession in the growth may be expected. The other methods of treatment are injection of various substances into the growth. Lactic, acid has been recently used by Ingals' with great success. The galvano-cautery electrode may also be used to advantage at times, but usually as an adjuvant to more thorough methods of removal. Finally, as a last resort, the patient may be submitted to the risk of an external operation. An operation for a naso-pharyngeal growth which cannot be removed by intranasal maneuvers is necessarily one of the gravest and most dangerous which the general surgeon can undertake; and statistics of the results both in intranasal opei'ations and in the preliminary external operations seem to warrant the preference of the best authorities for the former, while the latter procedure should be resorted to only when all other methods have been demonstrated to be absolutely of no avail. Fibro-mucous polypi are described by various writers as partaking partly of the character of the pure fibroma and partly of that of the edema- tous polypus within the nose. These growths are evidently fibromata of sluggish growth which have become edematous. Such growths usually have their origin partly, at least, within the nose. They do not bleed, nor do they tend by their pressure to invade other regions and absorb adjacent structures. They are usually pedunculated, and their removal is not attended with any great difficulties. They seem to be regarded as of rare occurrence; but it is probable that their comparatively trivial character has led to less frequent reports than of the more formidable fibromata. They are said by Bosworth to occur more frequently in females. The symptoms are those of post-nasal obstruction and irritation. Examination shows that the growth is paler in color and has a softer consistency and a smaller pedicle than the true fibroma. It is more movable. Treatment is correspondingly easier, it being usually jx>ssible to remove it with the cold snare introduced through the nose or to twist it from its attachment with forceps or fingers from the mouth. It shows little or no tendency to recurrence. IJnchondrorna.—Bosworth reports from literature only 2 cases of enchondroma of the naso-pharynx. Nasal obstruction, with headaches and some external deformity from pressure, were noted. Hairy Pharyngeal Polypi.—Reports of ten of these curious growths have been collected by Conitzer,2 who contributed to the number a case of his own. They contained not only hairs and their follicles, but also the other normal constituent parts of the skin. Most of them also contained cartilage. They were pedunculated tumors, attached usually to the posterior surface of the soft palate and more frequently to the left of the median line, but some 1 N. Y. Med. Journ., Sept, 19, 1896. 2 Deut. vied. Woch., No. 51, 1892.