7 he Nose, Mouth and Pharynx. 453 



supplied by the nasal branches of Meckel's ganglion. 

 When the sinuses are distended with pus and the infundi- 

 bula are not sufficiently patent to provide proper drainage, 

 then it may be necessary to trephine them, and 

 when this operation is indicated, the trephine should be 

 applied just above the inner angle of the orbit, since at 

 this point, the bone, forming the anterior wall of the 

 sinus, is very thin. 



When the mucous membrane of the ethmoidal sinuses 

 is inflamed and the cells are distended, pain may be felt 

 along the lower frontal region and is then due to irritation 

 of the nasal branches of Meckel's ganglion, which supply 

 the mucous membrane of these sinuses, also. When great 

 distention is present, the pus may make its way along the 

 line of least resistance, i.e., towards the orbit, and cause 

 protrusion of the eyeball. The antrum of Highmore, 

 when inflamed, cannot empty itself very readily if fluids 

 be present, since the orifice is situated at the upper and 

 posterior part of the inner wall. To give exit to contain- 

 ed pus it may be necessary to extract a diseased bicuspid 

 or molar tooth that has probably been the cause of the 

 trouble, but, if no such tooth be present, then the drill or 

 trephine should be applied to the wall of the cavity just 

 above the second bicuspid tooth. 



Nasal polypi, when present, are found most frequently 

 in the mucous membrane of the superior or middle tur- 

 binated bone. Asthma may be dependent, among other 

 reflex causes, on the presence of growths in the nasal 

 fossae, or in the naso-pharyngeal region, and here, it is 

 possible that the irritation is referred to the pneumogas- 

 tric nerve through the posterior branches of Meckel's gan- 

 glion, which communicate with the pharyngeal branches 

 of this nerve, or, the path may be up through the sensory 



