Other leprosy problems

Surgery for leprosy of the eyes is discussed elsewhere (30.2). Here we discuss leprosy as it affects the mouth and breasts. If a patient has even the most minimal injury anywhere, treat it with the very greatest care. Cover any break in his skin to prevent secondary infection, and splint the part to allow it to heal in a functional position.

THE MOUTH [s7]IN LEPROSY If a patient CANNOT CLOSE HIS MOUTH because his facial nerve is paralysed, his gums may dry and he may dribble food and drink and be socially unacceptable. Refer him to have his plantaris tendon or a strip of his fascia lata transferred to support his lip, by slinging it from his zygoma or temporalis fascia on both sides. Although this is a static sling, it will keep his mouth closed, improve his appearance, and stop him dribbling. If he has no lagophthalmos he may be able to have a temporal muscle transfer to reactivate his mouth.

THE BREASTS [s7]IN LEPROSY If a MAN'S BREASTS ENLARGE and trouble him (gynaecomastia), do a simple mastectomy by the Webster method as in P, Fig. 30-9. Make sure his breasts are enlarged and he is not merely fat. Make an incision half the way round the margin of the areola. Leave a small piece of breast tissue immediately under his nipple, and drain the cavity towards his axilla. Bring the drain out some distance from his areola, so that you can close the surgical incision and get a good scar. He will probably be very pleased with this simple procedure. Don't remove any fat, or you will leave a depressed area.

31 The surgery of tropical diseases