Lateral Wall of the Cavum Nasi in Man. 691 



I recently examined 125 adult specimens (including those of 

 my former series) of the lateral nasal wall and found that 53 of 

 them had accessory ostia communicating directly between the 

 maxillary sinus and the middle meatus — a percentage of 42.4. 

 Three of the specimens presented two such openings — a percent- 

 age of 2.4. 



J. A. Giraldes was apparently the first to consider this opening 

 from a developmental point of view. He came to the conclusion 

 ''dass in alien Fallen, wo diese abnorme Oeffnung besteht, sie 

 immer das Product eines pathologischen Vorganges und durch 

 eine wirkliche Perforation zu Stande gekommen ist." He how- 

 ever, considered this aperture much less common than it is, think- 

 ing it present in only 8 or 10 per cent of instances. Giraldes 

 bases his pathological theory on the fact that he had the ptivilege 

 of following the ''Entwicklungsphasen von der Verdiinnung der 

 Schleimhaut des Ganges bis zur volstandingen Durchbohrung." 

 Zuckerkandl corroborates the thinning of the mucous membrane, 

 but does not hold to the pathological theory. The latter author 

 has seen some cases where an accessory aperture was caused by 

 the gradual wearing of a ''zugespitzer Hakenfortsatz der Nasen- 

 scheidewand," which finallj^ resulted in an opening on the lateral 

 wall of the middle meatus. 



While some accessory apertures are obviously due to a patholog- 

 ical process as suggested by Giraldes, and others are caused in 

 a mechanical manner by spurs on the nasal septum, as suggested 

 by Zuckerkandl, we certainly must look elsewhere in the vast 

 majority of cases to find the genesis of this very common aperture. 



I agree that there is a thinning of the mucous membrane in the 

 position of the accessory ostium, but believe that the explanation 

 for this is found in the development of the sinus maxillaris. In 

 infancy the walls of the sinus maxillaris are comparatively very 

 thick. We know that the sinus cavity increases by the simul- 

 taneous growth of the sac and the resorption of surrounding 

 tissue, these processes taking place pari passu with the growth 

 of the face. In this manner the sinus walls become thinner, up 

 to a limit, as age advances. The thinning out apparently pro- 

 gresses unevenly, as evidenced by the very uneven walls of many 



