DRAINAGE THROUGH THE NASAL WALL ONLY
It was long ago proposed by John Hunter, and later by Mikulicz and Krause, that an opening should be made into the maxillary sinus from the nose. This operation has latterly been developed by Claoué and Réthi, and now has many supporters.
Operation. On the Continent it is frequently carried out under local anæsthesia, but chloroform is generally required. If the inferior turbinal comes down close to the floor of the nose, the anterior third or half should be removed (see [p. 587] and [Fig. 289]). The antro-nasal wall lying below the attachment of the inferior turbinal is then broken through with chisel and hammer, or a Krause’s trochar ([Fig. 285]), and the opening enlarged with punch-forceps ([Fig. 286]). For the anterior margin of the opening—the one most difficult to remove—special forceps which cut forwards have been designed ([Fig. 330]).
The opening is large enough to allow the introduction of curettes and of the application of treatment from the nose. The patient soon learns to wash out the sinus for himself, with a silver Eustachian catheter and Higginson’s syringe, as after the Caldwell-Luc operation.
Results. The advantages claimed for this operation are that it is simple, quicker, and as effective as the one with the opening from the canine fossa. But, of course, it does not allow any inspection, and only a partial removal, of the diseased contents of the sinus.
Still the results obtained are so satisfactory,[69] that it seems advisable to try it in the majority of cases as a necessary first step, even if the Caldwell-Luc operation has to be completed later. But where the case has a long history; marked obscurity on transillumination; a foreign body in the sinus; or where the Streptococcus pyogenes is the virulent organism, or where the streptococcus is associated with the presence of squamous epithelium and lymphocytes,[70] it adds little to the gravity or complexity of the procedure if the canine fossa be opened at the same time, the diseased cavity inspected, and everything completed under the one anæsthesia.
OPERATIONS UPON THE FRONTAL SINUS
CATHETERIZING AND WASHING OUT THE FRONTAL SINUS
Fig. 333. Catheterizing the Frontal Sinus. The anterior end of the middle turbinal has been removed.