A CLINICAL STUDY OF ODONTOMES. 
71 
forceps, while in other cases we have found, especially in sup¬ 
purating compound follicular odontomes, that we sometimes 
have great difficulty in dislodging firmly adherent flat pieces 
of cementum or dentine, from the walls of the pus cavity, and 
in such cases we find the best means to consist of placing a 
steel punch against the adherent piece perpendicularly and 
then giving it a short, sharp blow with the mallet, which by 
causing a yielding of the living walls, detaches the more un¬ 
yielding tooth-substance, when it can be readily removed with 
the aid of forceps. The free use of a four-tenths per cent 
aqueous solution of carbolic acid or one-twenty-fifth per cent 
of corrosive sublimate with sponge and syringe, greatly facili¬ 
tates the operation and guards against septic accidents. 
5. Unless free dependent drainage is afforded through the 
alveolus into the mouth or otherwise, this should be pro¬ 
vided for by cutting through the wall between the sinuses into 
the nasal passage and a sufficiently large piece removed to 
ensure its remaining open. If, through pressure of pus or a 
cyst, the wall between sinuses and air passages has been 
pressed against the septum, closing the orifice of communica¬ 
tion between sinuses and nostril, the fingers should be passed 
through the orifice, and the adhesions with the septum broken 
down. This may be aided by means of any suitable instru¬ 
ment passed up the nostril. Should these means fail to retain 
the displaced parts in their proper position, a bistoury may be 
introduced between the septum and wall and the latter divid¬ 
ed downwards toward the nostril, as far as desired, and if 
need be a portion excised, when the redilation of the air pas¬ 
sage may be further facilitated by a suitable tampon introduced 
either from above or below. 
6. The dressing and after-treatment should consist of 
thorough washings daily with a four-tenths per cent carbolic 
acid solution, careful search for remnants of tooth tissue for 
several days and plugging alveolus, odontome cavity and ex¬ 
ternal wound with pledgets of cotton or tow, saturated with 
carbolized oil and for a few days at least, heavily dusted over 
with iodoform. After four or five days, when the fetor has 
disappeared, the iodoform may be discontinued, and the plug 
