THE FACE. 71 



Excision of the Condyle of the Jaw. The condyle can be removed 

 through an incision 3 cm. long, running from in front of the ear along the lower border 

 of the zygoma. The temporal artery runs a centimetre in front of the ear with the 

 auriculotemporal nerve posterior to it. By care in recognizing the artery, it may be 

 saved and dragged posteriorly. The soft parts on the lower side of the wound with 

 the parotid gland and facial nerve are pushed downward. The condyle can then 

 be dug out, care being taken not to go beyond the bone and wound the internal 

 maxillary artery. 



Excision of the Mandible. In removing one-half of the mandible, the 

 incision is made from the symphysis along the lower border of the jaw to the angle 

 and thence upward as high as the lobe of the ear. If it is desired to take extra 

 precautions, the last centimetre of this incision, from the lobule of the ear down, may 

 be carried through the skin only. This will prevent wounding to any great extent 

 the parotid gland tissue, the parotid duct, and positively avoid injuring the facial 

 nerve. The incision, however, is rather far back to wound any large branch of the duct, 

 and is too low down to wound the facial nerve. If it is desired to carry the incision 

 higher than the lobule of the ear, it should go through the skin only. The facial 

 artery and vein will be cut just in front of the masseter muscle. The soft parts, 



Temporal artery 

 Zygoma 



FIG. 84. Excision of the condyle of the lower jaw. 



including the masseter muscle, are raised from the outer surface. In dividing the 

 bone anteriorly, it should be done .5 cm. outside the median line. This will be 

 about through the socket of the second incisor. The object of this is to retain the 

 attachments of the geniohyoid and geniohyoglossus muscles to the genial tubercles, 

 and so prevent any tendency of the tongue to fall back. The jaw is pulled out and 

 separated from the parts beneath, the mylohyoid muscle being made tense. Care 

 should be taken not to injure the submaxillary gland, which lies below the mylohyoid 

 muscle, and the sublingual gland, which lies above it. The lingual nerve is also liable 

 to be wounded if the knife or elevator is not kept close to the bone. 



As the detachment proceeds posteriorly, in loosening the internal pterygoid and 

 the superior constrictor, if care is not taken, the pharynx may be wounded. The 

 bone still being depressed and turned outward, the temporal muscle is to be loosened 

 from the coronoid process or else the process is detached and removed later. Access 

 is now to be had to the mandibular foramen at the mandib^ilar spine or spine of Spix. 

 The inferior alveolar artery is then secured and, with the nerve and sphenomandibular 

 ligament, divided. The jaw can now be well depressed and brought inward. The 

 temporomaxillary joint is to be opened from the front, having first cleared off the 

 attachment of the external pterygoid muscle. There is great danger of wounding 

 the internal maxillary artery at this stage of the operation. It lies close to the neck 



