As regards cessation of purulent discharge the result will depend on the extent of the sinus, the presence of complicated orbito-ethmoidal cells, and the skill of the operator. If the ethmoidal labyrinth has not been completely dealt with, one or two cells may continue to secrete. It may be wiser to leave them alone. In very deep sinuses a ‘dead space’ between the back of the Killian bridge and the posterior (cerebral) wall of the sinus remains open, and may continue to secrete if not cicatrized over evenly.
But secretion is no longer pent up in the fronto-ethmoidal group of cells, and the patient is relieved of headache, depression, and other symptoms of septic absorption.
THE OGSTON-LUC OPERATION
This operation was first described by Ogston,[78] but was independently conceived by Luc.[79] Its principle is to make a fairly free opening into the frontal sinus, and then establish a large communication with the nasal cavity. The inner part of the supra-orbital rim is sometimes destroyed. But the operation does not provide for the treatment of orbito-ethmoidal cells, the anterior ethmoidal region and the sp[h]enoidal wall are not exposed, and if there be a large orbital recess to the frontal sinus it cannot be satisfactorily dealt with.
Indications. But the Ogston-Luc procedure, or some modification of it, is still suitable in (1) exploratory openings of the frontal sinus, (2) when the sinus requires opening for a recent and acute infection[80], and (3) for mucoceles and suppurating mucoceles.[81]
Operation. A general anæsthetic is required. It is not necessary to shave the eyebrow, but the surrounding skin should be well purified. A curved incision is made through the eyebrow down to the bone along the inner third of the supra-orbital ridge, reaching from the supra-orbital notch to opposite the inner canthus. In the latter direction it can be extended if the ethmoidal region is chiefly affected, and if the ethmoid only requires exposing the incision is placed lower down.
With a raspatory the soft parts are turned upwards and downwards so as to expose the anterior wall of the sinus, which is opened with chisel and hammer. A probe will indicate its depth and direction. The opening is enlarged with bone-forceps sufficiently to allow inspection of the interior of the cavity, and permit of the passage into the nose being enlarged with forceps, curettes, or burrs. The polypoid mucosa occupying the sinus and the fronto-ethmoidal cells along the passage to the nose are carefully plucked away. A drainage tube or wick of gauze is inserted from the sinus down into the cavity of the nose, so that it can be withdrawn from the anterior nares at the end of twenty-four hours. The drainage tube is replaced by some surgeons. The frontal wound is sometimes closed at the time of the operation, and sometimes left open.
Results. These are variously given by different observers. Thus one author states that it will effect a cure in 85% of cases,[82] while another operated by this method in eleven cases, of which two died and not one was completely cured.[83]
The subject does not require further discussion, as most operators have now given this operation up in favour of the improvements wrought in it by Killian. Luc himself has abandoned it in favour of the Killian operation. The latter is undoubtedly to be preferred in all cases of well established chronic purulent sinusitis with fungating mucosa and involvement of the ethmoidal cells.