The two methods above described can be combined if necessary. This would be called for particularly in growths so large that they could not be attacked through the narrow vestibule of the nose, and for those in which the attachment is evidently in the ethmoidal region. This combination might be called for in any large innocent or malignant growth.
EXTENSION OF ROUGE’S OPERATION TO ALLOW OF ACCESS TO THE MAXILLARY ANTRUM
When the growth involves both the nasal cavity and the maxillary sinus Rouge’s operation can be extended so as to form part of the Caldwell-Luc operation (see [p. 631]).
The latter operation is modified as suggested by Denker ([Fig. 332]), i.e. the opening through the canine fossa is extended forwards until the nasal cavity is opened through the pyriform opening. This will give free access to the large cavity formed by throwing the antrum and the nasal chamber on the same side into one easily inspected space ([Fig. 332]). Hæmorrhage gives no cause for anxiety, there is no disfigurement, the original root of the implantation can be eradicated, and, if necessary, the operation can be repeated without difficulty. If the growth extends upwards and inwards to the ethmoidal region this infralabial opening can be combined with Moure’s operation.
Indications. This operation is suitable for any form of growth invading both the antrum and nasal cavities, and is therefore generally called for in malignant growths.
OTHER METHODS
The other methods for obtaining access to the nasal cavity through the face—described as the methods of Hippocrates, Syme, Dupuytren, Langenbeck, Lawrence, Ollier, &c.—are now only of historical interest. They all leave a scar on the face; bleeding is troublesome; they do not give a greatly enlarged field; and most of them do not bring the seat of disease any closer. With the advances made by rhinology the necessity for intervention through the face has become more infrequent.