OPERATIONS 



915 



OPERATIONS 



\geal polypus ; (a) nasal route ; the nasal bone 

 and nasal process of the superior maxilla are exposed 

 and forcibly displaced upward; (b) maxillary route ; a 

 tongue-shaped flap is marked out on the face, and a 

 large part of the maxillary bone separated and tempo- 

 rarily displaced inward. 16. For nephrectomy ; an in- 

 cision is made through the abdominal wall at the outer 

 edge of the rectus muscle, in the linea semilunaris, com- 

 mencing just below the margin of the ribs. 1 7. For 

 my; the division of the superior maxillary 

 nerve in the spheno-maxillary fossa by means of a long 

 tenotome passed into the fossa along the outer wall of 

 the orbit. 18. For osteotomy; the subcutaneous 

 i method. 19. For restoration of the lower lip ; (a) the 

 lower horizontal margin of the defect is prolonged on 

 . either side by incisions, which pass along the remainder 

 >f the lower lip, around the angles of the mouth and 

 nto the upper lip ; the portion of the lip is then 

 nobilized and drawn together by sutures. (6) By a 

 single flap derived from the chin. 20. For rhino- 

 plasty; the Indian method: a single lateral flap is 

 wrought from the opposite side, the apex being left 

 ittached at the inner angle of the eye on the side of 

 he deficiency, while the base comes from the ala of 

 id side. 21. For uranoplasty ; complete clos- 

 the cleft in the palate by dissection of rnuco- 

 :al flaps obtained from either side, and suturing 

 a the middle line. Langier's, for stricture of the 

 duct ; perforation of the wall of the duct and 

 he maxillary sinus, to drain the tears into the 

 ntrum. Lannelongue's : 1. For craniectomy; (a) 

 The vertex of the skull is exposed by means of a 

 ingle incision in its long axis and anarrow strip of parie- 

 al bone is removed close to the sagittal suture ; (b) The 

 ones of the skull are so cut as to produce osseous 

 .aps of various shapes. 2. For cleft-palate ; a rec- 

 angular flap of mucous membrane is brought down 

 rom the side of the septum of the nose ; the upper 

 ;:dge of the cleft is then freshened and the two sur- 

 faces brought together. Lariche's, for removal of a 

 ytmor of the nasopharynx ; a V-shaped incision is 

 nade, the ends of which run into either nostril, and 

 he apex is in the middle line one-fourth of an inch 

 telow the columna, which is then separated from the 

 ipper lip. Larrey's : 1. A method of performing 

 the same as Ditpuvtrcn s amputation 

 y the double flap method. 2. For amputation at the 

 '. ; lateral flaps are made by transfixion, the 

 . >mmon femoral artery being tied as a preliminary 

 I ep. 3. For amputation at the shoulder-joint : an 

 cision is made from the acromion to a point 2% 

 ches below, from which point anterior and posterior 

 liral incisions are carried down the arm, meeting on 

 e inner aspect ; after disarticulation of the bone 

 e flap is brought up and secured in the space made 

 • the gaping of the first incision. Lateral opera- 

 Dn, a method of performing cystotomy ; the lateral 

 •rineal operation. Lauenstein's, for iliac colotomv ; 

 e peritoneum is sutured to the skin ; a loop of intes- 

 ;en drawn out and the parietal wound closed 

 ;s passed through the meso-colon of the ex- 

 lded portion of gut ; finally, the serous covering of 

 ch limb of the prolapsed loop is stitched to the parietal 

 ritoneum, and the bowel is opened. Lawrence's 

 ir II.)-. 1. For extirpation of the lac ry ma I gland; 

 incision is made over the outer third of the orbit, 

 lowed by division of the external commissure and 

 tirpation of the gland. 2. For removal of a naso- 

 ;al polypus ; the nasal bones and nasal pro- 

 : the superior maxillx are cut through ; the 

 is then divided, and the nasal cavity exposed 

 ■ turning up the n>se. Lawson's, for blepharo- 



plastv : separation of the adhesions and dissection 

 up of the edges of the wound, followed by grafting. 

 Lebrun's : 1 . For cataract-extraction ; the incision is 

 made farther in the cornea than most operators make it. 

 2. Y ox entropion ; similar to that of Anagnostakii' oper- 

 ation. Ledran's, tics suturing the intestines. See Led- 

 ran's Suture. Lee's (He nry) : 1. For amputation of the 

 leg; a modification of Teale's operation, in which the 

 long flap is taken from the posterior aspect of the limb. 

 2. A method of performing embryotom y ; brachiotomy, 

 followed by perforation of the thorax and extraction 

 by the crotchet. 3. For traumatic cerebral abscess ; 

 the same as Fenger's operation. 4. For varicocele ; 

 transfixion by two pins and figure-of-eight turns of a 

 ligature, followed by subcutaneous division of the 

 veins. Le Fort's: I. For amputation of the foot ; 

 a modification of Pirogoffs operation, in that the 

 section of the os calcis is more nearly horizontal, all 

 the upper part of the bone being removed. 2. For 

 procidentia uteri; denudation of the anterior and 

 posterior walls of the vagina and the formation of a 

 'ongitudinal septum. Lembert's, for suture of the 

 intestine ; the interrupted suture is u 5 ed, and a fold of 

 serous, or of serous and muscular, tissue is picked up 

 on one side of the wound ; the needle is then carried 

 over to a corresponding point on the other side of the 

 wound, where a similar fold is picked up. Lenoir's, 

 for amputation of the leg; a modified circular oper- 

 ation ; a circular incision is made above the malleoli 

 and below the point at which the bones are to be 

 sawn ; this is joined by a vertical incision carried up 

 along the inner side of the tibial crest ; the skin-flaps are 

 then dissected up and the remaining soft parts are di- 

 vided down to the bone at the level of the saw-line. 

 Lente's, for stricture of the rectum ; incisions are made 

 in the anterior and posterior median lines. Leten- 

 neur's, for plastic purposes; the quadrilateral gap is 

 closed by a flap freed from below and displaced upward. 

 Leucke's, a method of vtexfoxxaing gasfro-enteroslomy ; 

 in order to expedite the operation the first present- 

 ing portion of the small intestine is attached to the 

 stomach. Leveille's, for iridodialysis ; it differs 

 from Scarpa's method only in the previous depression 

 of the lens. Levis 's : I. For the radical cure of 

 hydrocele ; the injection of twenty drops of pure car- 

 bolic acid into the tunica vaginalis testis after withdraw- 

 ing the fluid. 2. For varicocele ; after ligation of the 

 varicocele the ligature is tied over a piece of rubber 

 tubing so as to maintain the tension of the thread. 

 Liebreich's : I. For cataract-extraction ; the incision 

 is carried farther into the cornea than usual. See also 

 Lebrun's Operation. 2. For strabotomy ; the incision 

 is made at the lower edge of the muscle's insertion ; 

 the conjunctiva and capsule of Tenon are separated 

 as far as the semilunar fold ; the tendon is divided and 

 the vertical incision is extended upward and downward 

 to the necessary extent. Lignerolle's : 1. Y ox ampu- 

 tation of the foot ; the astragalus is preserved in situ. 

 2. For subastragaloid disarticulation ; by a short ex- 

 ternal, and a long internal flap, taking in part of the 

 sole of the foot. Linhart's, for the removal of a 

 tumor of the naso-pharynx ; an incision is made from 

 the root of the nose to its tip, and is extended into 

 the nostril of one side : the nasal bone is forcibly 

 turned to one side after having been separated 

 from its fellow. Lisfranc's : I. For ampu- 

 tation of the fingers at the metacarpophalangeal 

 joints; it is done by rounded lateral flaps of equal 

 size, the base of each corresponding to the joint- 

 line, and the free extremity to the level of the web. 

 2. For amputation through the foot; disarticula- 

 tion through the tarso-metatirsal joints. 3. For am- 



