TREPHINING SUPERIOR MA NIL LARY SINUSES. 



37 



Under the influence of disease the sinuses may extend far 

 beyond their normal location or may contract or become 

 largely obliterated by being filled with new bone or soft 

 tissue. The median portion of the superior maxillary sinus 

 on the inner side of the bony conduit of the trifacial nerve, 

 NF, Plates IV-X, can not always be completely drained 

 through the opening SM, Plate III, and provision for this 

 must then be made by trephining into the lower part of the 

 frontal sinus and thence breaking through the superior 

 turbinated bone, ST, Plates IV-V, into the nasal passage 

 or at times it may be feasible to break through the inner 

 wall of the superior maxillary sinus on the median side of 

 the nerve conduit into the nasal cavity. If the inferior 

 maxillary sinus is also involved good nasal drainage 

 may be had by breaking down the inter-sinusal partition 

 and then penetrating the inferior turbinated bone at IT, 

 Plates IV-V, and inserting through this opening a long and 

 thick strip of gauze which is brought out through the nostril 

 and the ends tied together on the side of the face to prevent 

 displacement. Retain this in position, renewing daily until 

 the permanency of the opening is assured. 



It generally occurs in extensive empyema of the sinuses 

 that an opening in the turbinated bone takes place by 

 necrosis and in some cases affords the desired drainage 

 while in the majority the pathologic opening is so placed 

 that it is incomplete. 



Leave all wounds entirely open and irrigate daily with 

 antiseptic solutions. 



Dangers. Care must be exercised to not injure the 

 superior maxillary division of the trifacial nerve, NF, 

 Plates IV-X, either in trephining or after the sinuses have 

 been opened. The bony conduit of this nerve is in rare 

 cases entirely resorbed by pressure from dental cysts or 

 other causes, leaving it stretched across the cavity as a white 

 nacrous cord, intensely sensitive. Any injurj^ to this nerve 



