The Head and Neck 8i 



Epitheliomata. This malignant form of neoplasm occurs only 

 in animals of advanced age, growing at the inner edge of the lip, 

 usually the lower one. 



Symptoms and Diagnosis. The tumor is observed at the outset 

 as a small flat growth, which later progressively ulcerates. The 

 ulcer has a raw, granulating appearance, or it may be hidden by a 

 thin scab. In some cases it is mammillated. It gradually increases 

 in size and may invade the entire lip or extend to the maxilla. 

 Secondary enlargements of the cervical and submaxillary lymphatic 

 glands generally develop. Differentiation from labial ulcers is not 

 difficult. 



Treatment. Total excision must be practised. When the tumor 

 is small it is removed by A-shaped section through the entire 

 thickness of the lip the base corresponding to the free border of the 

 lip. The edges of the wound are then brought together with 

 interrupted sutures carried completely through all the component 

 textures. When the grow.th is extensive, the autoplastic operation 

 of Syme should be undertaken. Syme's operation consists in pro- 

 longing the A-shaped incisions to form an X and continuing them 

 in an oblique direction downwards. The two quadrilateral sections 

 of skin thus formed are separated from the subjacent tissues by 

 dissection and made to pivot on their base, and are then united by 

 sutures, the margin of each portion becoming the free border of the 

 lip. The operation is completed by stitching the mucosa to the skin. 

 The two small triangular spaces gradually fill in by granulation. 



When the lymphatics are only slightly involved they should also 

 be ablated, but when they are extensively involved operative meas- 

 ures are contraindicated. 



Sarcoma. This is, properly speaking, a tumor of the maxilla, 

 as it originates either in the periosteum, the medulla, or the en- 

 dosteum, but as it encroaches on the buccal cavity, it will be con- 

 sidered here. It is observed more often in the upper jaw than in 

 the lower. It may attain great dimensions and tends to rapidly in- 

 vade neighboring parts, such as the nasal chambers, the orbits, and 

 even the cranium. It often recurs after ablation but is not very 

 metastatic to the neighboring lymphatic glands, though it some- 

 times undergoes generalization. 



Symptoms and Diagnosis. This neoplasm is frequently over- 

 looked in the earlier stages particularly when situated on the inner 



