OPERATION FOR CERVICAL FISTULA 



341 



enlarging the original orifice of the tract above, a large seton 

 is passed between the two points. If there is an additional 

 orifice on the opposite side a second seton is passed from 

 it through the whole neck to the surgical incision. 



These setons are treated with antiseptics and turned 

 about daily for twenty days, or as long as the amount of dis- 

 charge indicates that the cavity is yet unprepared for cic- 

 atrization. When the discharge continues to be abundant, 

 especially from the uppermost orifice, an incision large 

 enough to admit the hand, paralleling the muscle fibers, is 

 made at the level of this orifice. The hand is then passed 

 into the incision and the cavity explored to discover the 



Fig. 163— Cervical Fistula. 



obstacle against gravity drainage. By boring with the hand 

 or with the aid of a cutting instrument a direct, unobstructed 

 communication is established between the two openings, 

 and then a large seton is again inserted to maintain it. Ex- 

 tensive resection of suspected -dead elements is not attempted 

 on account of their inaccessibility and the utter impossibility 

 of determining the extent of the affected zone. 



The setons are dispensed with as soon as the discharge 

 has diminished to the amount of pus usually produced by 

 setons. Thereafter antiseptic irrigation is depended upon as 

 long as the tract remains open. 



