OPERATIONS ON THE SKULL, FACE, LIPS, ETC. 91 



Operation. — On account of the narrowness of the nostrils, 

 the removal of the polypi is often a matter of great difficulty, 

 and the bone forceps or trephine may have to be made use 

 of. General anesthesia is attended with risk, although of 

 great advantage, because the operation is a \er\ painful one 

 and requires delicate manipulation. Adrenalin and cocaine 

 in solution, injected into the nostrils or applied with a brush, 

 are effectual in most cases. The former acts as an astringent 

 to the bloodvessels, and the latter as a local antesthetic. The 

 poh'pi are generally multiple, and are removed either with 

 a snare or by ligature. If both these are impossible to applv, 

 they may be destro)'ed with a fine electric cauterj-, or the 

 nostril may be trephined or split with fine bone forceps. 



The Prognosis should alwaj-s be guarded, because, as a 



Fig. 63. — Polypus Snare (Blake's). 



general rule, the removal of one poh'pus mereh' makes room 

 for another to take its place. An operation is, ho\\'e\'er, 

 worth a trial in all cases, because there is alwaj's the chance 

 that the polypus which can be seen is quite alone, as happened 

 to be the case in the subject of the illustration. In this 

 instance the polypus had (Fig. 62) quite a long pedicle, 

 and the snare removed it intact right at the root ; there was 

 no evidence of recrudescence nor of an}' others six months 

 later. 



After-treatment. — The nostrils in se\'ere cases should be 

 svringed with solution of adrenalin two or three times daily 

 for a week or ten daj's. 



