Lateral Wall of the Cavum Nasi in Man. 689 



to the infundibulum ethmoidale — occasionally actually extending 

 into the latter. This accessory ostium is usually single but occa- 

 sionally it is duplicated, and rarely three accessory apertures are 

 present in this portion of the middle meatus. The aperture must 

 not be confused with the duplication of the ostium maxillare 

 which is located in the depth of the infundibulum ethmoidale; 

 however at times very near its dorsal extremity. 



Nathaniel Highmore, who apparently was the first anatomist 

 to describe the maxillary sinus, does not mention anything about 

 this accessory ostium. J. Cruveilhier refers to an orifice in the 

 middle meatus, apparently the accessory ostium of the sinus 

 maxillaris, which he considers the ''plus ordinairement V orifice 

 du sinus maxillaire.'^ Further he says that ''Get orifice semble 

 manquer quelquefois; on le trouve alors au niveau de la partie 

 moyenne de I'infundibulum; on dirait, dans ce cas, que le sinus 

 maxillaire communique directement avec les sinus frontaux et non 

 avec les fosses nasales." He also calls attention to the fact that 

 the maxillary sinus may possess two apertures: ''II n'est pas 

 rare de voir le sinus maxillaire communiquer a la fois et dans le 

 meat moyen et dans I'infundibulum.." 



From the above we must conclude that Cruveilhier considered 

 the accessory aperture as the more regular ostium of the sinus 

 maxillaris, but recognized that it is inconstant. He erroneously 

 thought that the ostium maxillare, which is constant and com- 

 municates with the. infundibulum ethmoidale, was not always pres- 

 ent, and when it was present, that the maxillary sinus communi- 

 cated with the frontal sinus and not with the middle meatus. We 

 only rarely have direct communication between the frontal and 

 maxillary sinuses (Cryer, Brophy, and Schaeffer have reported 

 such cases) . While from a practical point of view the frontal 

 sinus communicates with the maxillary sinus in many cases, due 

 to the infundibulum ethmoidale acting as a gutter between the 

 frontal region and the ostium maxillare, we have no right to say 

 that the two sinuses are in communication with each other (i^Vec^/?/. 

 In all cases the sinus maxillaris communicates indirectly with the 

 meatus medius by way of the the hiatus semilunaris. Gosselin, 

 however, recognized that the sinus maxillaris constantly communi- 



