526 QUARTERLY REVIEW OF LITERATURE

When the tonsil was exciued, a walnut-sizrtl lirm tunlor n-as found, Fvhich on his- tologic examination proved to be a neurinoma. OnI?- one similar case could be found in the literature. It was thought that the tumor originated in the brancheu of the glosuo- lthar)-ngeal uerre.

E. P. S.

Beitrag zur Operation der Lateralen, Branchiogenen Halseyte. (Operations of the Latwal, Branchiogenic Cysts of the Neck.) P. RehBk. BIonatschr. f. Ohrenh. i-6: 137, bpril- June, 1930.

Cysts of the neck are congenital, cluned listulae, which develop laterally from the branchial clefts or medialI?- from the thyroglossal dwt. The former are recognized his- tologically )J- the preseucr of lymphatic tissue while the latter are surrounded by small islands of thyroid tissue.

Extirpation is not alTap easy-: since they are often projecting into the deeper struc- tures of the neck and 8ometimes are attached to them. The author describes a case in which the cyst was attached to the external surface of the constrictor phar,wgis. He excised it partly from an external approach, while the deep part eras removed twelve dags later from the pharynx, including a tonsillectomy.

E. P. S.

FRACTURES AND DISLOCATIONS OF THE JAWS

Fractures of the Facial Bones. W. R. McKenzie. Arch. Otolaryng. 52: 237, August, 1950.

Fractures of the malar-zygomatic, arch are treated as early as the condition of the patient permits.

Operation

A right angle incision is made ox-er the canine fossa on the involved side and the mucoperiosteum carefully retracted. This procedure esposes the anterior wall of the antrum and the various fracture lines. The fragment8 of bone are easily seen and may be removed or retracted out. of the field to insure proper inspection.

All these fragments, or as many as possible, should be carefully preserved, and their periosteal attachments should not be injured or destroyed. An opening just large enough to permit proper visualization and manipulation is made through the anterior wall. Blood clot, secretion, and bone fragments are removed bp suction and forceps. A piece of plain 1 inch (2.5 cm.) strip gauze is introduced, which will about half fill the antral cavity. A heavy Kelly clamp is inserted against this gauze cushion, and sticient pressure in a direction upward or upward and outward is exerted to reduce completely or to overcorrect slightly the fractured bones. The strip gauze cushion should be removed, as some parts of it ma.y be caught between bone fragments and cause dificult and painful removal forty-eight hours later. An opening of sufiicient size to provide adequate drainage and assure easy postoperative treatment is made through the nasoantral wall. The importance of antral drainage is stressed by almost all authorities, to prevent infection and possible osteomyeliti,s of the bony wall. Adequate doses of penicillin and sulfonamides should be started immediately after operation to minimize or to prevent these complications. If osteomyelitis should occur there i8 great possibility of localized areas of infection appear- ing under the 8kin of the face with rupture onto the surface, causing additional scarring with deformity. The antrum is firmly packed with dibucaine gauze and the end with- drawn into the nose. The incision is closed with tm-o or three black silk or cotton sutures.

The malar-z-gomatic arch is now inspected and palpated, comparisons being made with the uninvolved side to make certain that the deformity has been properlr and com- pletely corrected. If there has been ox-ercorrection, it is easily adjusted by proper presvure of the thumb and fingers against the bones inrolvecl. The pack is removed in 48 houre.