OCR Text |
Show ABSCESS or THE FRONTAL SINUS. ABSCESS or THE FRONTAL sums. The disadvantage of the harelip-forceps is, that they do not take a firm hold of the lip. They grasp unequally, and when the incision is but half performed, the lip is apt to slip from them-Sometimes the dryness of the lip in the first cut, passages, always acutely sensible and subject to inflammation, becomes either from such general inflammation as we see in catarrh, or from injuries, or the neighbourhood of disease, the seat of a more confirmed disorder, and of suppuration. In the frontal sinuses inflammation is attended with dull heavy head-ach, and pain, in the part. The pain is more severe on stooping; the integuments over the sinuses are swelled, and puffy. The patient is sens1ble of a peculiar of- fensive smell, and it will probably be found, that at intervals, there has been discharge of matter from the nose. All this 28 gives a firm hold, while in the second, the forceps or lip, be» ing bloody, they slip. The pins are introduced as in the instance of cancerous lip, and the precautions are of course the same. The operation may be done as successfully in an infant, as at the age of 1d years. Sometimes the fissure of the lip is accompanied with a cleft in the palate, and a deficiency of the bones. When part of the maxillary bone stands projecting out of its place, it may in young subjects be violently pressed down, and made to adhere in its proper place. The deficiency of the palate will diminish, as the child advances in years. On examining the bones of the face of children, with a cleft palate, I have found that the diminutiveness of the upper maxillary bone of the one side, was more apparent than real. The fissure is owing to.the bone of one side, being thrust laterally, and of course made also to project somewhat. If this centre piece of the palate project irregularly, I have said it may be broken down, and forced into its place. But if the jaw-bone of one side be only pushed laterally, which ,is the most common kind of deformity, then I imagine by a compress operated upon, by an elastic steel bandage, coming. round the head, the bones may be gradually brought into their places, so as to fill up the fissure of the palate. The cure may then be completed, by the usual operation on the cleft of the lips. Or the operation being done on the lip, the after treatment will be, to bring the pieces of the superior maxillary bone together. ABSCESS IN THE FRONTAL AND MAXILLARY SINUS. may be, and still we must use general remedies, nor think of performing so formidable an operation, as applying the trepan, on the frontal sinuses. It is much more likely to be a com mon catarrhal affection, than a formidable disease, or it may prove merely head-ach, assisted by the imagination of the patient. But when there has been injury previously, when there are symptoms of a beginning affection of the brain, when there is occasional sickness, or much languor, or oppression, or any thing like epilepsy, or paralysis, a slighter indi- cation will satisfy the surgeon of the propriety of an operation. If there be a collection of matter, and an inflamed sinus slowly affecting the brain, the delay of an operation may leave us full of regret. If the frontal sinus is to be opened, we must proceed with all the precautions, which we should employ in the more common occasion of using the trephine. 1. We have to recollect the thinness of the outer shell of the bone. 2. The obliquity of the inner table. 3. The partition which divides the two cells. ‘ ~ . . THE sinuses both of the frontal bone, and the superior maX~ illary bone, are subject to disease. The membrane of these 4. we have to re» member, that the lining membrane of the cells will probably be thickened, and that if diseased it looks like a suppurating brain, and has actually been mistaken for such! 5. That, when the trephine has taken out the circle of the outer table very neatly, the membrane will still be entire, and require to be opened with the lancet. ' ran-f1"; Ii]- -‘n-.:‘,..,,n-v~...v¢\,.," ,A.,p_ ‘pr f"review mum 29 by emollient injections. The cure will then be conducted No tents or dressings ought to be introduced into the cavity. |