The Röntgen rays give such valuable information as to the size and relations of the cavity, as well as to diseases in its cavity or walls, that a radiograph should be taken in all cases (Figs. 343 and 344).
Fig. 344. Radiograph of the Sphenoidal Sinus. This is a sequel to the preceding illustration. The front wall of the sinus has been broken through, and the beak of the forceps is now shown inside the sphenoidal cavity.
SOUNDING AND WASHING OUT THE SPHENOIDAL SINUS
Fig. 345. Catheterizing the Sphenoidal Sinus.
Indications. Lavage alone may be sufficient for acute or recent cases, but in chronic forms of suppuration a larger and permanently patent ostium must be established, both to allow of more effective drainage and of treatment of the interior of the cavity.
When the interior of the nasal chamber is in a normal condition it is only possible to catheterize this cavity in a limited number of cases. The region of the middle turbinal and olfactory cleft is carefully prepared with cocaine and adrenalin. A pledget soaked in the mixture is inserted between the middle turbinal and the septum, and pushed backwards until it reaches the anterior wall of the sinus.
A canula is then inserted in a sloping direction inwards and upwards diagonally across the plane of the middle turbinal until it impinges on the nasal surface of the sphenoid, in the neighbourhood of the ostium (Fig. 345). The latter is found by feeling with the tip of the catheter. The opening is never visible in health. It may lie a little external to the direction of the olfactory cleft—about 5 millimetres from the middle line.
