Other methods. The sphenoidal sinus can also be opened and treated during Killian’s operation on the frontal sinus (see [p. 648]).
It has been proposed to approach the sphenoidal sinus by first traversing the maxillary antrum. Such a complicated route, involving extensive destruction of tissue, has no advantage over the direct and simple method described. Attempts to reach the sphenoidal sinus from the naso-pharynx are not practical. This is easily seen by observing the thickness of the floor of the cavity depicted in [Fig. 345].
OPERATION IN MULTIPLE SINUS SUPPURATION
Before starting treatment in a case of multi-sinusitis a complete examination should be formulated. The importance of making the differential diagnosis as complete as possible cannot be overestimated.
In initiating treatment attention should be directed first to the ethmoidal region. The ethmoid should be attended to in all cases of suppuration in the frontal sinus. It is generally necessary, in any case, to clear it away to gain access to the sphenoidal orifice. It is well to remove it before or during operation on the maxillary sinus. The sphenoidal sinus should be catheterized, and, if infected, the orifice will require enlarging and the cavity treating. A frontal sinus should be washed out several times before deciding on a radical operation. It not uncommonly ceases to secrete after the ethmoid has been cleared.
The radical operation on the frontal sinus should not be embarked on until the ethmoid and sphenoid have been attended to. A radical frontal operation should take precedence of the maxillary, unless both cavities are operated on at the same time.
CHAPTER VI
OPERATIONS INVOLVING THE NASO-PHARYNX: OPERATIONS
FOR RETROPHARYNGEAL ABSCESS: OPERATIONS FOR
NASO-PHARYNGEAL ADENOIDS
METHODS OF OBTAINING ACCESS TO THE NASO-PHARYNX THROUGH THE NOSE
Many growths in the naso-pharynx, whether originating in the space or descending into it from the posterior choanæ, can be removed by the following method.