To tie or not to tie: that is a question which has been exercising the minds of some otologists for several years. Since 1880, when Zaufal suggested ligature of the internal jugular vein in cases of thrombosis of the lateral sinus—a suggestion which on the face of it seemed logical enough—the orthodox teaching has been that if a thrombosed lateral sinus is found the internal jugular vein is to be ligated, and before the completion of the mastoid operation, lest the jarring of the work on the bone should displace portions of clot. Alexander1 went even further and taught that if the diagnosis can be made with reasonable certainty before the operation, the first step should be ligature of the jugular vein. Many otologists, particularly those of the older school, still adhere rigidly to this teaching and ask why an operation which has given satisfactory results in the past should
ATKINSON EM. TREATMENT OF LATERAL SINUS INFECTIONS WITHOUT OPERATION ON THE JUGULAR VEIN. Arch Otolaryngol. 1938;27(2):169–177. doi:10.1001/archotol.1938.00650030178005
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