In the case of small children it is sometimes recommended that a piece of muslin should be placed over the mouth, and that the practitioner should then apply his lips to those of the patient and by blowing forcibly through the mouth drive out the foreign body by the blast of air from the post-nasal space. Or the same principle may be applied by insufflating the air from a Politzer’s bag through the opposite nostril. Both plans are alarming and seldom effective.
The after-treatment consists of some simple cleansing lotion and soothing ointment.
REMOVAL OF RHINOLITHS (NASAL CALCULI, OR CONCRETIONS IN THE NOSE)
These concretions are almost unknown in children, in whom foreign bodies are met with most frequently. A general anæsthetic is, therefore, not so often required, otherwise the remarks on the removal of foreign bodies will be found to apply to the extraction of calculi. With the help of cocaine and good illumination they can easily be removed with a strabismus hook, Lister’s ear hook, or a pair of fine probe-pointed nasal forceps with serrated extremities. In some cases where the calculus has sent prolongations into the recesses of the meatus, it might first be necessary to crush it. In that event a general anæsthetic may be required.
The after-treatment consists in simple cleansing measures. Subsequent syringing of the nose should be done from the opposite side.
OPERATIONS UPON THE TURBINALS
Indications. In many cases of hypertrophic rhinitis it is necessary to remove portions of redundant turbinal tissue. It is never desirable—and it can only rarely be necessary—to remove the whole of the inferior turbinal. ‘Turbinotomy,’ or amputation of the whole inferior turbinal, was recognized as an operation some years ago. But it was never generally accepted, as it was always realized that the highly important physiological functions of the lower spongy bone could not be spared. Improved technique, particularly in being able to correct deformities of the septum without the sacrifice of any mucous membrane (see [p. 603]), now enables us to rectify nasal stenosis with the sacrifice of much less turbinal tissue.
The middle turbinal is not of so much importance in the physiology of the nose, and the whole of this body is not infrequently removed. This may be done not only because it is diseased, but even a healthy middle turbinal may require amputation in order to approach the accessory sinuses or diseases in the deeper regions of the nose. Part of the healthy inferior turbinal may also require removal—as in the radical operation on the maxillary sinus.
As these operations will be referred to frequently later on, and as their performance enters into different groups of operation, they will be described first.