The cause is very apparent whenever these sinuses come to be opened; the cavity itself is generally stuffed with fungating mucosa, and the fronto-ethmoidal cells—where the lavage never penetrates—are affected in the same way.
OPENING THE FRONTAL SINUS IN ACUTE SUPPURATION
It is rare for this to be necessary. The contents of the cavity generally make their way through the natural ostium, before any of the bony walls give way. Still, the posterior (cerebral) wall may yield, giving rise to meningitis or cerebral abscess. The treatment of this complication is given on [p. 650]. The orbital wall may be penetrated, with the formation of an orbital abscess which should be evacuated. It is most uncommon of all for the anterior wall to give way. When this does occur the abscess should be opened through an incision designed on the principle given later on for chronic empyema (see [p. 652]).
KILLIAN’S OPERATION
At the present time the Killian operation is the one most generally employed.
Indications. The indications for this operation are thus given by Killian himself:—
1. Failure of other operations.
2. Presence of fistula or abscess, or indications of necrosis.
3. Symptoms of intracranial complications.