A CASE OF SUM BKA OF THE HYOID BONE. PHARYNGEAL TUMOR TREATED BY INCISIONS AND IN- JECTIONS THROUGH THE MOUTH. CURE. By CLINTON WAGN ER, M.D., Physician to Metropolitan Throat Hospital, New York. [Reprinted from the Ohio Medical and Surgical Journal.! COLUMBUS: NEVINS & MYERS, BOOK AND JOB PRINTERS 1877. A CASE OF SUL «i OF THE BIOD) BONE. PHARYNGEAL TUMOR TREATED BY INCISIONS AND [if , JECTIONS THROUGH THE MOUTH. CURE. By CLINTON WAGNER, M.D., Physician to Metropolitan Throat Hospital, New York. [REPRINTED FROM TfiE OHIO MEDICAL AND SURGICAL JOURNAL I COLUMBUS: NEVINS & MYERS, BOOK AND JOB PRINTERS 1877. CASE OF SYNOVIAL BURSA OF THE HYOID BONE. Mrs. S., aged 37, a native of New Jersey, consulted me, February 2, 1877, for hoarseness. She stated that between three and four years ago, she first noticed her trouble, which began with a tickling in the throat and slight cough. These symptoms increased, and at times she was conscious of a feeling of pressure internally, and upon the left side of her throat. About two years ago, the external swelling made ijs appearance. Her suffering, at no time, has been great, her annoyance arising chiefly from inability to sing; her voice became rough, and the formation of the higher notes quite impossible. On examination, I discovered a swelling, about the size of a walnut, lying over the thyro-hyoid space, and which imparted to the finger the feeling of a fibro-cystic tumor. A laryngoscopic examination revealed a large tumor at the base of the tongue, resting upon the superior and poste- rior surface of the hyoid bone, and extending from the lateral wall of the pharynx on the left, from which it appeared to take its origin, to beyond the median line, pressing the epi- glottis backwards and to the right side; the left ventricular band was pushed beyond the median line, and the left vocal cord could not be seen. Whilst to the eye it presented, in the mirror, the characteristics of a cystic tumor, to the touch it seemed dense, firm and resisting. The external tumor I regarded as either an enlargement of a small superior lobe of the thyroid gland, which some- times fills the space between the thyroid cartilage and hyoid bone, or as a bursa which is occasionally seen at the acute 4 angle of the thyroid; but I could not satisfy myself that there was any connection between it and the internal tumor. After a consultation with Drs. Asch and McBurney, I deter- mined to incise the pharyngeal tumor. This was done with the curved laryngeal sharp-pointed knife, by aid of the lar- yngoscope. The incision was made at about the center of the part exposed to view, from which escaped, with a spurt, as nearly as I could estimate without actual measurement, about two and a half ounces of a clear, amber-colored fluid, resembling synovia. The external swelling disappeared simultaneously with the collapse of the pharyngeal tumor, establishing the fact of the communication between them. I was prepared to employ the galvano-cautery loop, in the event of the mass proving solid instead of cystic. . A chemical and microscopical examinat.on of the fluid was made by Prof. J. N. S. Arnold, with the following result: " Chemical.-Reaction neutral; white precipitate on boil- ing ; dense precipitate with nitric acid; precipitate, with acetic acid in small quantity, the deposit being redissolved on the addition of an excess of the acid, therefore, no mucine present, but paraglobulin exists in considerable quantity. " Microscopical.-Flattened epithelial cells, with large nu- clei in large numbers, and of various forms ; leucocytes ; red blood globules ; compound granulation corpuscles." The sac refilled within a week, and I repeated the opera- tion. The patient was requested to call at the expiration of three weeks, at which time the distension was apparently as great as before the first operation. An incision was again made, and the fluid allowed to escape. I then injected four- teen or fifteen drops of the tincture of iodin'e, by means of a hypodermic syringe, such as is used by veterinary surgeons, and to which I had attached a long, fine tube, bent to the laryngeal curve. Before discharging the iodine, I introduced the point of the syringe through the opening made by my knife, and directed it downward and forward to the hyoid 5 bone. Tnis operation I repeated three times, at intervals of fifteen, ten, and twenty-one days. Five weeks after making the last injection, no trace of the tumor remained. With the removal of the pressure upon the left side of the larynx, the parts resumed their proper places, the left vocal cord became visible, its action was restored, and the hoarseness disappeared. The hoarseness was due to irritation from pressure of the external branches of the laryngeal nerve, and the inability to give the higher notes, from want of action of the crico-thyroideus muscle supplied by the same nerve. This case is remarkable on account of the pharyngeal tumor; bursae mucosae on the thyroid cartilage, at the point known as the Pomum Adami, are occasionally met with; bursae synoviae of the hyoid are more rare. Cohen (Diseases of the Throat) mentions a variety found in the structures at the root of the tongue, which he calls the supra-hyoid bursa, situated on the upper border of the hyoid bone, between the posterior insertions of the genio-hyoid and genio-glossal muscles. It appears to be abnormal, and is only occasionally met with. He does not state that an internal tumor exists in these cases, nor can I find mention of this complication in any of the authorities whom I have consulted. In regard to the treatment of this variety of bursa, internal incision and injection have an advantage over the external treatment, the patient escapes a troublesome fistula and an unsightly scar. 53 West 35th Street.