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Plastic Operation for the Relief of Pharyngeal Occlusion Miltons upon the Anterior Num



Dr. B. Farquhar Curtis read a paper with the above title, and in connection with it presented two patients.

Dr. Kammerer said that in one instance he had removed part of the maubrium, the left clavicle, and first rib in order to ligate the first portion of the left subclavian for the relief of an aneurism. The artery was ligated about three-quarters of an inch from the aorta. The patient succumbed to haemorrhage after four weeks. The specimen was subsequently shown at one of the meetings of the Surgical Society. In that case Milton's osteoplastic resection could not have, the speaker thought, been employed successfully, owing to the fact that the aneurism im pinged on the clavicle and the bone had to be removed piecemeal. In such cases, where great care had to be taken to avoid lesions of the sac, atypical operations alone are possible, with removal of just so much of bone as is called for by the individual case.

In cases where the aneurism is attached to the posterior sur face of the bone, it is very difficult to do an osteoplastic opera tion. For ligation of the innominate artery, however, which lies more superficially, the procedure is an excellent one.

DR. CURTIS said he agreed with Dr. Kammerer that the osteo plastic operation would be dangerous in cases where the sac of the aneurism was closely connected with the bone. In the case he had shown, however, the principal portion of the tumor involved the second portion of the subclavian, although there was aneuris mal dilatation of the first portion of that artery and of the caro tid. The axillary artery was also dilated, and the opposite axillary artery is still about the size of a man's thumb. In fact, the patient is suffering from a general dilatation of the vessels.

Dr. Curtis said he thought that Milton's operation would be found equally satisfactory in ligating the left subclavian.

artery, bone and portion