On admission: Temperature 100°; skin over right superior maxilla red and œdematous; thick purulent discharge from right superior meatus, sequestrum in region of right cribriform plate; naso-pharynx, chest, and abdomen normal; urine, sp. gr., 1014; trace of albumen. Fundi (of eye) normal.
May 16—No pus found in antrum on exploration and flushing. Patient taking 60 grs. pot. iod. (t. i. d.) and mercurial inunction. Temperature in ear usually higher than that in mouth until just before death. June 8.—Mortuus est.
Post-mortem Examination.—Skull. Base of brain was bathed in thick greenish pus, principally in the neighborhood of the pituitary body, the pus extended back over the pons and medulla. No brain abscess. Ventricles contained more than normal quantity of fluid. Frontal sinuses and cribriform plate of ethmoid and ethmoidal cells normal.
To right of the sella turcica there was some necrosis of the walls of the sphenoidal sinus. Probe readily passed from base of skull through sphenoidal sinus into the nose. Large free opening from said sinus into nose, which sinus was full of muco-pus. Cavernous sinus not thrombosed. Right antrum of Highmore contained about a dram of thick glairy mucus.
Palmer.
Killian, Prof. Gustav.—Case of Acute Perichondritis and Periostitis of the Nasal Septum of Dental Origin.—Münch. med. Wochen., No. 5, 1900.
There have been recorded two cases of perichondritis of the septum due to alveolar periostitis. Suppuration of dental cyst was cause in the following case.
A young man had pain in second left upper incisor; two days after obstruction of nose supervened, with pain in forehead and high fever. There was a sudden copious discharge of fetid pus from right nostril seven days later. The entire mucosa of the septum was raised from the cartilages, etc. It is considerably swollen over right side of the triangular cartilage, but less so posteriorly. Severe headache in forehead and frontal eminence, and still little fever. The pus was escaping through a small hole into the left nostril. It was freely incised. The triangular cartilage was disintegrated, and the pus had burrowed between the soft tissues and vomer and vertical plate of the ethmoid. The choanæ were constricted by thickening of the septal mucous membrane. The wound healed in a fortnight without sequestrum, while the toothache lasted but two days.
Six months later the patient had recurrence of pain in the same tooth of two months’ duration; it was extracted and pus continued to exude from the socket. A probe, passed 2½ centimeters to the floor of the nose and septum, showed a cavity covered with membrane in the anterior parts of upper jaw, which was a cyst at the root of the tooth. The anterior cyst walls were removed with bone forceps, and the remainder scraped. The cavity gradually healed.
The cyst probably broke through under the septal mucous membrane. In exceedingly few cases of perichondritis does the process extend to the osseous septum. Only once has the author seen record of a case which was as extensive as this. The offensive odor also points to a dental origin.