Case of enormous deep-seated tumour of the face and neck successfully removed by operation / by James Spence.

  • Spence, James, 1812-1882.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Case of enormous deep-seated tumour of the face and neck successfully removed by operation / by James Spence. Source: Wellcome Collection.

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    together with the increasing deformity, rendered her almost unfit for any duty, and gave rise to great mental depression, so that she was most anxious to have the tumour removed at all hazards. The consideration of these first two questions resulted in a decision favourable to operative interference. It now remained to consider how far the size and connexions of the tumour admitted of removal by operation without immediate risk to the patient’s life; and to plan the procedure by which this could be most readily and safely effected. The great bulk of a tumour, though always a source of risk from the extensive incisions requisite for its removal, the amount of surface exposed, and the proportional hemorrhage, venous and arterial, does not necessarily render the operation more difficult; on the contrary, the very size gives a power of leverage which often facilitates the dissection. But when the mass is so situated as to present a large surface it may be adherent to, or in close connexion with vitally important parts, then the operation required for its removal becomes most formidable. These elements of difficulty and danger were present to their fullest extent in my patient’s case; for, besides the enormous bulk of the tumour, it was developed beneath the sterno-mastoid, and its deep surface was neces¬ sarily in the closest relation with the great vessels and important nerves in the cervical region, from the lower jaw to within an inch of the sternum, and stretching backwards to the margin of the trapezius muscle; whilst the facial portion felt fixed in the parotid region, as if deeply nitched behind the ramus of the jaw; and it could be felt projecting towards the fauces within the mouth. The bulk, form, and position of the tumour rendered it impossible to ascertain positively whether or not it adhered at any point to the sheath of the vessels; and the apparent mobility of a large cervical growth can never altogether be depended on; for, even if it involve or be adherent to the vessels or their sheath, these, being loosely connected, move with the tumour on the more fixed parts. But in the face of these risks I felt warranted to operate, on the following grounds:—First, as I have already said, the simple character of the tumour made me feel secure that, though it might displace, press upon, or even adhere to the sheath of the great vessels and nerves, it would not absolutely involve them. Secondly, the absence of any engorgement of the veins of the neck on either side, or of any marked alteration in the arterial supply of the right side of the face, made me pretty sure that neither the internal jugular nor the carotid could be very closely or extensively involved. Whilst the