When the operation has been completed the post-nasal plug is removed, and it is well to pass the forefinger of the left hand well up into the posterior choanæ to detect and push forwards any masses of growth which may have been driven backwards.
Hæmorrhage generally ceases with the usual remedies (see [p. 576]). It is better to avoid all plugs.
Dangers and complications. This operation in careless or inexperienced hands is not free from risks. The chief danger is from injury to the cribriform plate, as any damage in this area, occurring in the septic conditions which generally call for operation, is generally followed by fatal meningitis.
In addition to the usual precautions, particular attention should be paid while manœuvring in the anterior part of the space between the septum and the outer nasal wall. Here the punch-forceps are not directed backwards against the main mass of the sphenoid, but, as the head has to be extended in order to approach the anterior area, they follow an obliquely upward direction which brings them into dangerous proximity with the floor of the cranial fossa—which dips down lower in front than it does posteriorly. Great care, therefore, is taken to avoid any thrusting or boring movements with the forceps. They are first made to press outwards as much as possible the opposing walls of this narrow region, so that polypoid masses can fall between the blades under good inspection.
Occasionally the os planum is perforated, resulting in emphysema of the eyelids or an ecchymosis like a ‘black eye’. An orbital abscess may follow (Lack).
METHODS OF OBTAINING DIRECT ACCESS TO THE NASAL CAVITIES AND NASO-PHARYNX
LATERAL RHINOTOMY, OR MOURE’S OPERATION
Direct inspection and treatment of the deeper regions of the nose, the naso-pharynx, the ethmoidal labyrinth, and the neighbouring area of the maxillary sinus, is well secured by the following operation, which has been fully described by Moure of Bordeaux.[66]
Indications. This operation is particularly suitable for malignant growths originating in the upper or inner walls of the maxillary sinus, the ethmoidal labyrinth, the deeper regions of the nose, the naso-pharynx, or the sphenoid. It might be required for very vascular naso-pharyngeal fibromata with extensive prolongations. It is very suitable for necrosis—generally syphilitic—of the sphenoid when threatening the base of the brain.