If the entrance to the nose be tender, it may be smeared with a little menthol and boric ointment; ice-cold cloths may be kept across the bridge of the nose; and pain or sensitiveness can be relieved by a few doses of phenacetin or some similar anti-neuralgic.
Insufflations of antiseptic powder are useless, and the nasal cavity should be left alone for 24 or 48 hours. A nose lotion should then be used two or three times a day, until the local condition is again inspected at the end of a week.
Any attempt to destroy the roots of polypi by the galvano-cautery is useless and dangerous.
REMOVAL BY FORCEPS AND CURETTES
Indications. This operation is indicated in all cases of recurring polypi and extensive caries of the ethmoid, but the plan of operation is also suitable for the removal of some cases of papilloma, fibroma, enchondroma, or osteoma.
It can also be employed in certain cases of malignant disease in the nose. When the growth appears to be limited to the nasal fossæ, and particularly in cases of sarcoma, the above operation may be indicated. Even when glands are present this may still be the preferable operation, as glands can be removed at a separate sitting.
Possibly a better method of deciding the case of malignant intranasal disease suitable for this operation will be founded on the discovery of the original attachment of the growth. If located towards the front of the nose in the anterior part of the middle meatus, removal can be carried out on the lines described.
Contra-indications. If there be any mental symptoms suggesting that intracranial inflammation has taken place already, the patient should be carefully examined before operation is embarked on. It is unsuitable for debilitated and elderly subjects. In patients over 60 with recurrent polypi it is wiser to secure relief by a series of small operations under cocaine.
Many neoplasms and inflammatory hypertrophies, such as mucous polypi, can be removed satisfactorily per vias naturales by the method to be described. Naturally the details will vary with the situation and extent of the disease to be removed. The following description applies particularly to growths or hypertrophies springing from the ethmoidal region:—
Operation under cocaine. The nose is carefully prepared with adrenalin and cocaine, the strips of moistened ribbon gauze being carefully tucked in between the septum and the ethmoidal region, as well as between this latter and the outer wall. The inferior turbinal and the front of the nasal cavity should be similarly prepared, so as to diminish vascularity, retract the healthy tissue, and thus increase the space for operating in, while lessening the risk of wounding the septum and so causing adhesions. At least one hour should be given for the solution to act. The operation is done with the patient sitting upright in the ordinary examination chair, with the body craned forward somewhat, and the head supported and held in focus by an assistant. Ready to the surgeon’s hand should be some lengths—about a yard—of 1-inch to 2-inch ribbon gauze, and a vessel of cold sterilized water into which it is easy to shake off the growths as they are removed with the forceps.