THE NOSE. 



101 



The spheno-ethmoidal recess is the cleft above the superior turbinated bone; into 

 it opens the sphenoidal sinus. In order to examine and reach the openings of any 

 of these sinuses, it is practically necessary to take away a part or all of the middle 

 turbinated bone before they can be exposed to view. When this is done, they can 

 be probed, washed out, drained, etc. (see Fig. 125). 



The frontal sinuses begin to develop about puberty. They occupy the lower 

 anterior portion of the frontal bone. Their size and extent vary considerably. The 

 usual size is from the nasion below to 

 the upper edge of the superciliary ridges 

 above and laterally from the median line 

 to the supra-orbital notch. These limits 

 may be exceeded considerably. They 

 may go as far out as the middle of the 

 upper edge of the orbit or even nearly 

 Co the temporal ridge. The anterior and 

 posterior walls are separated a distance 

 of 0.5 to I cm. The distance which they 

 extend back over the orbit and upward 

 also varies. The two sinuses are sepa- 

 rated by a partition which is often to one 

 side of the median line, so that it is apt 

 to be encountered in opening the sinus 

 through the forehead. The two cells 

 often differ greatly in size and may be 

 divided into various recesses by incom- 

 plete septa. They have the infundib- 

 ulum as their lower extremity, which 

 passes into the hiatus semilunaris be- 

 neath the middle turbinated bone and empties into the middle meatus. The frontal 

 sinuses are frequently the seat of suppurative inflammation. This gives rise to 

 pain and tenderness in the supra-orbital region and to a discharge from the cor- 

 responding nostril. This discharge can be seen coming from beneath the anterior 

 extremity of the middle turbinated bone. Owing to the proximity of the opening 

 into the maxillary sinus, pus, coming down the hiatus from the frontal sinus, may 



Pic 



121. Outer wall of nose, showing the superior, mid- 

 dle, and inferior turbinate bones. 



Probe in the lachrymo- 

 nasal duct 



Hiatus semilunaris 



Opening of lachrymo- 

 nasal duct 



Frontal sinus 



Anterior ethmoidal cell 

 Middle ethmoidal cells 



Posterior ethmoidal cells 



Sphenoidal sinus 



Bulla ethmoidalis 

 . Superior turbinate 

 Middle turbinate (anterior 

 half removed) 



Inferior turbinate 

 FIG. 122. View of outer wall of the nose and accessory cavities. 



Opening into 

 maxillary sinus 



pass into the maxillary sinus, thus simulating disease of that cavity. In order to 

 wash out the sinus, cocaine may be first applied to shrink the nasal membrane ; then 

 sometimes one is able to pass a probe or irrigating tube into the hiatus semilunaris 

 and thence up into the sinus. By removing the anterior extremity of the middle 

 turbinated bone access to the hiatus semilunaris is more readily obtained. In cer- 

 tain cases the frontal sinus is opened either through the supra-orbital region or 

 entered through the roof of the orbit at its inner upper corner. The glabella is the 



