CATHETERIZING THE MAXILLARY SINUS
It is rarely possible to enter the antrum through its natural ostium. The attempt may be made after the local use of cocaine and adrenalin (Fig. 320).
Fig. 320. Catheterizing the Maxillary Sinus.
PUNCTURING THE MAXILLARY SINUS FROM THE NOSE
Indications. It is chiefly employed as a diagnostic test. As a curative measure it is seldom successful except in comparatively recent infection. If the case be uncomplicated by suppuration in other cavities, if the teeth in the upper jaw on the same side be intact, and if the patient be anxious to avoid more severe measures and be willing to undergo the discomfort of a daily puncture, lavage has been reported as successful when repeated 27 times, even in a case with a history of 17 years’ duration.[67] But under the circumstances just mentioned it is wiser to recommend the establishment of an antro-nasal communication (see [p. 637]).
Fig. 321. Lichtwitz’s and Moritz Schmidt’s Antrum Needles.
Operation. This is done under local anæsthesia from the inferior meatus. One pledget of cotton-wool, soaked in cocaine and adrenalin, is carefully tucked under the inferior turbinal on the affected side, and another is applied to the septum. At the end of 20 minutes a straight Lichtwitz’s or curved Moritz Schmidt’s (Fig. 321) hollow needle is passed under the inferior turbinal and introduced upwards and outwards as near as possible to the centre of its attachment. The handle of the needle is tilted against the cartilaginous septum, while the point is directed towards the malar eminence. When it is felt to encounter the thin, membranous part of the antro-nasal wall it is easily thrust through (Fig. 322).
