An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    without cutting away the turbinal, which should be removed only when entirely diseased. BONY AND CICATRICIAL OCCLUSION OF THE POSTERIOR NARES. Bony occlusion of the posterior nares is often congenital. In operating for its removal the size and extent should first be ascertained by the combined exploration of the anterior nares with a curved probe and with the finger in the posterior nares. When this is determined it should be removed with either a drill or bone-cutting forceps. Great care must be exercised, for the position of the bony formation frequently renders the operation extremely hazardous. In the case of a child that recently came under the care of the writer, the posterior nares were completely closed with a firm bony formation which had existed from birth. This was removed with a Curtis drill passed along the floor of the nose; when an opening had been made, one blade of a small right-angular bone-cutter was passed through and the bone chipped off until an opening of the requisite size had been made. Cicatricial tissue may close the opening secured, and must be removed as fast as it forms. Trichloracetic acid has been praised as the cautery least apt to be followed by return of the occluding tissue. Stenosis of the naso-pharynx due to the adherence of the soft palate to the pharynx may be congenital or it may be due to ulceration resulting from acute inflammation, as in diphtheria, from struma or tuberculosis ; but is most commonly the result of syphilis, which in children may be hereditary, but in adults is usually acquired. The stenosis is rarely complete, there being nearly always a small opening between the two cavities. Complete stenosis in the case of a child recently came under my observation. The readiness with which severed cicatricial adhesions reunite renders these operations extremely unsatisfactory; accordingly a great many devices have been resorted to to prevent reunion of the parts after having been sepa- rated, such as the insertion of rubber tubes, plates of hard rubber, metal rings, air-bags, and mechanical dilations. The most successful plan is that devised by Nichols, who with a curved needle passes a heavy silk thread through each side of the cicatricial tissue and ties it in the center. The knot is then slipped around back through one of the openings so as to be entirely out of the way, lying in the naso-pharynx, and is allowed to remain there until complete cicatrization has taken place around the thread in a manner similar to the treatment of web-fingers. The string is then removed, and by inserting an angular knife in one of the openings the adhesion between the two openings is cut away. The best plan for keeping the cut surfaces apart until healed is by means of a small flat piece of hard rubber attached to and held in place by a string passed through each nostril and tied in front of the septum. In some cases daily dilatation of the parts is necessary to maintain the proper size of the opening, and in moderate stenosis only such dilatation may be necessary. SURGICAL INTERVENTION IN DISEASE OF THE ACCESSORY SINUSES has been dealt with earlier (page 966), and but few points need be here added. Maxillary Sinuses.—The disease of the maxillary sinus most fre- quently necessitating surgical interference is empyema. There are five methods for gaining access to this cavity : (1) Through the natural opening;