The  position  of  the  patient  should  be  with  the  head  slightly  lowered
29


450  DISEASES   OF   EAR,    NOSE   AND   THROAT.
and  the  body  slightly  elevated  so  that  gravity  will  aid  in  preventing
the  entrance  of  blood  into  the  larynx.
The  first  incision  suggested  by  Sir  W.  Ferguson  or  by  Huguier
should  extend  from  a  line  slightly  below  the  inner  canthus  parallel
with  the  nose,  round  the  alae  to  near  the  center  of  the  lip  (Fig.  117),
completely  severing  the  lip.  An  incision  is  now  made  through  the
skin  and  the  vestibule  of  the  nose,  connecting  with  the  incision  in
the  lip.
If  the  growth  is  large  and  the  alveolar  process  is  involved,  a  third
incision  is  made  from  the  corner  of  the  mouth  backward  and  upward
sufficient  to  expose  the  angle  of  the  jaw.  With  all  bleeding  points
secured,  a  fourth  incision  is  made  along  the  gingivo-labial  border
down  to  the  periosteum.  The  flap  of  the  fascia  is  dissected  back
from  the  maxillary  process  until  the  entire  bone  is  exposed.  The
incisor  tooth  is  next  extracted.  With  a  narrow  saw  in  the  cavity,
the  floor  of  the  nose,  alveolar  process  and  hard  palate  are  completely
sawed  through.  The  saw  is  again  directed  to  severing  the  jaw  from
its  attachment  with  the  malar  bone.  The  sawing  is  continued,  if
a  complete  removal  is  desired,  up  to  and  through  the  bone  forming
the  floor  of  the  orbit  and  last  through  the  nasal  process  of  the  max-
illary bone.
