12 
W. L. WILLIAMS. 
Knowing full well by experience the invaluable advantage 
in diseases of the sinuses to be derived from a free, dependent 
nasal exit for morbid products, one finger was passed 
through the foramen of communication between sinuses and 
nasal cavities and then forced down between the septum nasi 
and the displaced internal wall of sinuses. A probe-pointed 
bistour}^ was then passed along the finger and the displaced 
wall divided as low down toward the nostril as practicable. 
The bistoury then turned and including a piece of the wall 
about three-quarters of. an inch wide, the incision was carried 
back in a parallel line to the starting-point, thus detaching and 
removing enough of the wall to ensure a free opening, which 
was made more effectual by pressing a good sized antiseptic 
cotton tampon between the septum nasi and the edge of the 
incised wall at its lowest part. This tampon was removed 
daily for two or three days. 
This, however, failed to drain the maxillary sinus at its in¬ 
ferior part, and accordingly a second opening was made over 
the fang of the first molar (fourth tooth) at the zygomatic 
ridge, and on cutting through the maxillary bone, instead of 
finding a considerable intervening sinus, we came directly 
upon a mass of dental tissue and the real nature of the affection 
was now revealed, and upon questioning the owner regarding 
his history of strangles it was found that it was without other 
foundation than purulent discharge from the nostril of the af¬ 
fected side and some degree of dyspnoea. 
The opening through the maxillary bone was enlarged 
and the odontome well bared, a steel punch placed against 
it at right angles, when a few sharp blows with a mallet shat¬ 
tered the tumor, which was now found to consist of several 
cysts with walls of dental tissue. 
Some of the cysts were three-quarters of an inch in diame¬ 
ter and contained a reddish-brown semi-transparent fluid. Por¬ 
tions of these cyst walls are shown in Fig. i c, d, e and f , and 
are composed apparently of dentine and enamel. 
After the tumor had been well comminuted and the pieces 
well removed, leaving only about one-and-one-half inches of 
the crown, the latter was driven into the mouth by means 
of punch and mallet and removed. 
