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Show "432m mum OF THE OPERATION FOR WRY-NECK. 30 31 ABSCESS or THE MAXILLARY SINUS. the discharge remains toetid, the patient can force the fluid i'rom the mouth into the cell by the tongue merelyas. PERFORAT‘ING THE MAXILLARY SINUS FROM THE ALVEOL'L THE abscess of the maxillary sinus is marked by a colourless swelling of the cheek, over the bone, by a pulsating pain, deep seated in the cheek, generally fixed‘to the cheek, though sometimes extending over the whole side of the head, but not increased on pressure, by an oozing of matter by the side of one of the molares, sometimes by a discharge of matter from the nose. We find indeed that the most frequent complaint of our patients is that of foul matter flowing into their mouth, when they lie in bed. If in this disease there should form an ulcer on the check, or just under the orbit, the disease is still to be relieved, by the operation performed below, since that opens into the floor of the antrum while the attempts to preserve the opening on the cheek, and to throw in injections there, will increase the de- formity, even if they should be in the end successful in curing the disease. \V‘RY-NECK. IN the case of wry-neck, which is submitted for operation, We are to be careful to distinguish it from rheumatism the mastoid process, is as it were drawn towards the sternum, tooth-ach and anervous affection of the face. When it arises from tooth-ach, succeeded by high inflammation, or comes after fever, or succeeding to injury of the bones of the face, or has any such ostensible cause, it is favourable; and by the the head is inclined to that side, and the chin is pitched up. On examining the cause of this, the mastoid muscle of that drawing of one of the molares, or perforating the sinus, and thus allowing a free exit to the matter, the disease will be cured. All the treatment necessary in this disease, is to draw the second molaris, and then to pass up a stilette of the size of a writing quill, into the sinus; nature seems to point out that this is the better place for perforating, though it be sometimes done just above the alveolar process of the molares. The objection to this last place is that without taking away a piece of the gum, it is difficult to keep the perforation open. If the perforation be made in the side of the sinus, then the instrument, which makes the hole for the point of the tree phine, will answer. When a patient presents with the sinus opened, and the matter running from it, the operation having been done some time before, we are not to despond, but to enlarge the opening for it has probably been made too small. After the operation the swelling may require fomentationsy or astringent washes. When the swelling has subsided, and side, will be feund to be smaller than that of the other side ; it feels stringy and hard; it will not stretch when the muscle of the other side acts so, that it suddenly checks the turning of the face towards the same side. The disease of the muscle which occasions this, is a very singular one. The muscle is changed into a firm substance, which to the knife cuts like gristle, and which is equally incapable of contraction, or stretching. I have chiefly seen the. portion of the muscle which arises from the sternum, diseasedin this manner ; it would appear that to others the clavicular portion, has oftener presented thus changed in its texture. In one instance I traced this disease, to a fall, and twist of the neck. One cannot imagine a more likely cause of this disease, than a strain upon the inuscle. I have seen a similar disease, in a portion of the biceps cubiti, producing the effects of an anchylosis, in fixing the elbow-joint. The only thing that the surgeon has to consider deeply is, whether the twist of the head proceeds from this disease or not. Whether the vertebra: have not greatly suffered, or it ' Tincture of myrrh, and a little camphorated spirit diluted, is the W355 when the discharge is fatidv |