KUHNT’S OPERATION
In this operation the entire anterior wall of the frontal sinus is chiselled away, so as to allow of the soft parts covering it being pressed down into the cavity until they are applied to the posterior wall. This, naturally, effects a complete obliteration of the cavity, but in order to secure it the orbital ridge has frequently to be removed to such an extent that a frog-like prominence is given to the eye, and the resulting disfigurement is very marked. Besides, this operation does not deal with the orbital recess of the sinus, or the orbito-ethmoidal cells—the most important part of the operation. In fact, the only advantage of this operation—complete obliteration of the sinus—is secured by Killian’s operation, which also allows these regions to be dealt with, permits free drainage into the nose, and avoids disfigurement.
OPERATIONS UPON THE SPHENOIDAL SINUS
Fig. 343. Radiograph of the Sphenoidal Sinus. The beak of a punch-forceps is seen in a posterior ethmoidal cell (which has been opened) and pressing against the anterior wall of the sphenoidal cavity.
Surgical Anatomy. In operating on this sinus there are many anatomical and pathological points which it is desirable to remember. Only a few of them can be recalled.
The cavity is seldom absent, although it may be quite small. Its size and conformation may be irregular. Thus in one instance it may extend far out into the wing of the sphenoid, while in another it may be even smaller than a posterior ethmoidal cell invading the body of the sphenoid bone and lying above it.
While the sphenoidal sinus on one side is very small the opposite one may be so large that it comes in relation with the optic groove of the opposite side.
The anterior wall of the sphenoidal sinus can be opened with safety. The roof comes into close relation with the structures round the sella turc[ic]a. The outer wall is close to many large blood-vessels which might cause troublesome hæmorrhage if wounded. The upper outer wall may be as thin as paper.
There may be deficiencies present in the bony walls, so that, for instance, the mucous membrane of the sinus and the dura mater may be in direct contact.