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The Stewart and Ryfkogel Methods in the Surgery of Epithelioma of the Lip

H. A. L. Ryfkogel, M.D.
JAMA. 1913;60(12):926-927. doi:10.1001/jama.1913.04340120053028.
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To the Editor:  —I fear Dr. Stewart has not read my article very carefully, for I state that two weeks after the removal of the lip, I do a radical dissection of the cervical lymph-nodes including the submental and submaxillary. At the second operation the facial arteries are cut; but as the flaps are now healed in place their preservation is no longer necessary. To save space I referred to a previous article in which I advocated a very thorough neck dissection in these cases, and as I do not like to have such an extensive wound in continuity with the mouth, I do a two-step operation. I also remove the lip wide of the growth, and my operation permits this by allowing full use, without tension, of the loose skin of the neck. In Dr. Stewart's original article he states that there is sometimes "an offensive suppuration"


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