SAWS AND THEIR APPLICATION IN NASAL SURGERY

ALLEN DeVILBISS
1892 Journal of the American Medical Association  
Woakes used small saws, and Siler recommended them for the removal of bone tissue in the nose. Bosworth reported a series of 166 operations of deformities of the nasal septum, with a saw of his own device and since that time they have been used almost exclusively to any other. It is the best instrument for removing small bony projections that I have used, yet there is trouble in using it where the septum is deflected and a broad surface to be removed. In these cases soon after we commence
more » ... r we commence sawing, the spaces between the teeth fill up, the saw will fail to cut rapidly, and we are compelled to use pressure, clean the teeth or change saws. I have also had cases where it was impossible to enter the saw far enough, either below or above, to have stroke sufficient to do any satisfactory work to¬ ward the removal of the parts, also in operations which require a larger access to the nasal passages than the natural ones for the removal of tumors from the cavities or naso-pharynx, which require incisions of bone to be made for their removal. Some years ago I had quite a series of the above class of cases and with the instruments I could com¬ mand at that time my success was not as satisfac¬ tory as I wished for. It was this that led me to undertake to try to de¬ vise a saw so constructed that I could use its extreme end for cutting purposes,attacking the tumor directly in front. I have been endeavoring to produce such a device ever since, sometimes thinking I had succeeded, at other times failed, but to-day I take pleasure in showing you the instrument that is the result of my prolonged effort, which has not only proven satisfac¬ tory to myself but to others. You will see by examination that it is not much thicker than the ordinary saw and that its edges are protected by steel shields so that it may come in contact with soft parts and not injure them. Being so narrow that they pass into the slot the saw cuts. It can be used in connection with or without grooved director. If the operator uses the director he should place it above the portion that is to be separated from the septum, then pass the shield of the saw along its narrow groove, thus directing it through the surfaces to be cut with precision and certainty. I have seen cases where the grooved director could not be passed above the part. In these cases a hole can be bored through with a twist drill connected to the cable used to run the saw, so that it will do its work quickly. The grooved director can be passed through the opening thus made and the saw used as before described. This is not necessary, as a rule, in hands that have practiced the use of the saw with a view of studying direction. The shield must be kept in the groove of the direc¬ tor and the cutting end of the saw parallel to a line that would correspond to the side of a normal sep¬ tum. The distance which the saw is to be carried into the nasal passages can be determined by measuring first with a probe, the distance from the anterior part of the nose to the posterior surface of the part to be removed, then place this measurement on the saw. This is not necessary to one accustomed to its use as the sense of touch will tell us when it is through. In this way we remove the part much more quickly and with less pain to the patient, and the plane of the part left will be straighter than it could possibly have been made with the ordinary saw used, which is liable to leave an uneven surface. Bosworth, in his book on diseases of the nose and throat, page 304, makes the following statement in operations for fractured septum with thickening: "Objection has been made to these operations that they result in ulcération. Now, I wish to say, in as positive a manner as possible, that in no case have I had any such result. The subsequent treatment is nothing. The healing process requires no attention. The parts heal up kindly, and, as a rule, with no un¬ pleasant symptoms during the process. It has been charged that bad cicatrices result. Again, I say that I have seen no such result in any case. The mucous membrane re-forms over the cut surface and at the end of two months it would be difficult to recognize the fact that any cutting had been done. Too much importance cannot be laid on the necessity of a per¬ fectly straight, smooth-cut surface. In one or two instances in operating I bent my saw, which is ex¬ ceedingly flexible, in such a way as to make a hollow cut, sawing in a curve, as it were, leaving a depres¬ sion on the surface of the septum. Whenever I have made such a mistake there has been exceedingly great annoyance from delayed healing, owing to the fact that mucus and bloody pus accumulated in the depression and formed crusts, and thus markedly interfered with the healing process. And herein, it seems to me, lies an objection to the rougher opera¬ tion of the gouge and the forceps in removing these obstructions, as leaving an irregular surface for the lodgment of mucus and secretions. We meet with no ulcérations in the nasal cavity, except as a result of syphilis or some blood-poisoning. "Delayed healing may occur,but not ulcération,af¬ ter the operation, and delayed healing, I am positive Downloaded From: http://jama.jamanetwork.com/ by a University of Arizona Health Sciences Library User on 06/03/2015
doi:10.1001/jama.1892.02420180001001 fatcat:edgs4f4targqlcmsskuo2vx2fa