TREPHINING THE SUPERIOR MAXILLARY SINUSES 27 



the alveoli of the molars for naked, eroded tooth fangs or 

 for fistulae leading down into the dental alveoU. If dental 

 disease is recognized, the trephining of the sinus is to be 

 supplemented by repulsion of the offending tooth as 

 described on page 7. 



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, Figs. 4-10, can not always be completely drained 

 through the opening SM, Fig. 3. 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, Figs. 4 and 5, 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, Figs. 4 and 

 5, and inserting through this opening a long and thick strip 

 of gauze which is brought out through the nostril. The 

 ends of the gauze are then tied together on the side of the 

 face to prevent displacement. Retain this in position, re- 

 newing 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 generally 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 not to injure the 

 superior maxillary division of the trifacial nerve, NF, Figs. 



