The cavities are to be washed out first with clear tepid water, and thereafter daily with an astringent solution such as that used for injecting the nose. If the discharge does not escape freely by the lower orifice its exit may be facilitated by drawing a tape through the sinuses, from the upper to the lower, and retaining it there by a knot on each end.
Marked fœtor of the wound will usually indicate necrosis at the edge of the wound, and demands the use of bone forceps or chisel to remove the offending bone.
A cure is affected by the restoration of the membrane to its natural state, or in other cases by the filling up and obliteration of the cavity by granulation.
ABSCESS OF THE FALSE NOSTRIL OR TURBINATED BONES.
Structure of turbinated bones: suppuration or abscess, obstructed breathing, treatment, puncture, plugging, injection, trephining.
The turbinated bones are two fragile bony structures attached to the outer wall of each nasal chamber. The posterior half of each bone closes the corresponding nasal sinuse; the anterior half is rolled upon itself as a sheet of paper might be, and is accordingly open along one side. In this latter a collection of pus may result from severe inflammatory action and the resulting discharge may become somewhat chronic. The flow is greatest after the nose has been raised, from the pus having previously gravitated into a sac in the lower end of the bone. The pus may moreover pass backward into the larnyx from the raising of the head and induce a violent fit of coughing. Sometimes the inflammation has extended to the bones covering the nose which are bulging and tender. The thin turbinated bone gives way under the distension, bulges into the nose, and often stops the passage of air through that side. This symptom and the appearance of the swelling cause a close approximation in symptoms to nasal polypus. The facts that it supervened on a severe coryza, that it fluctuates on pressure if within reach of the finger, and that pus escapes when it is punctured, exclude the idea of polypus.
Treatment. Puncture of the abscess inside the nose, plugging and daily astringent injections will usually rapidly cure. Gamgee, Jessen and others, recommend trephining of the bone above the nose and washing it out daily, adding that an extensive removal of the bone will correct any existing bulging and deformity.
NASAL DISCHARGE FROM CARIOUS TEETH, ETC.
Ulceration into sinus from caries, loss of molar, overgrown molar. Fœtor, tenderness. Foreign body in the nose.
In cases of a diseased molar tooth in the upper jaw, food getting firmly impacted in the hollow space, irritates the pulp in the fang and the adjacent bone until the progress in ulceration reaches the nasal chamber or sinuse and a nasal discharge is established. If an upper molar tooth is lost the molar formerly opposed to it in the lower jaw grows out and sets up the same train of symptoms. In all cases then in which nasal gleet is associated with much fœtor and with difficulty in eating, a careful examination of the teeth should be made. (See Diseases of the Teeth).