A case of extensive chronic empyema of the frontal and ethmoidal sinuses with exophthalmos : operation; recovery / by Arnold H. Knapp.

  • Knapp, Arnold Herman, 1869-1956.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: A case of extensive chronic empyema of the frontal and ethmoidal sinuses with exophthalmos : operation; recovery / by Arnold H. Knapp. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    can be thoroughly explored, as it can only be done by way of the orbit, and properly drained by way of the nose. The sphenoidal cavity can be directly inspected. It seems to me that the establishment of perfect drainage is the important step in the entire operation. This is secured by the broad opening into the middle meatus of the nose, requiring, as in our case, the removal of the entire os planum of the ethmoid. * Kuhnt' removes the anterior wall of the frontal sinus in the usual cases of frontal empyema, and also employs a similar, though less extensive incision along the concavity of the or- bital margin at its upper and inner angle, if the sinus is small in size, as shown by transillumination, and if the lower wall of the frontal sinus or the ethmoidal cells are involved. In two cases, Nos. xiii. and xiv., which were operated on accord- ing to the latter, or the author's second, method, the anterior and lower walls of the sinus were removed, and the ethmoidal cells curetted. The wound was drained from in front. He considers a broad communication between the wound and the nose to be very undesirable because of the danger of in- fection from the nose. This danger of infection is, I think, exaggerated, the wound granulates rapidly, and the nasal passage can be kept comparatively clean by frequent irriga- tion. The deeper parts of so extensive a wound cannot be satisfactorily drained by an opening in the face. Griinwald* has suggested a similar incision and method of procedure from studies on the cadaver. He was not satisfied with the cosmetic results of the Jansen operation and prefers the method of resecting the anterior wall of the sinus. Many methods, associated with the names of Panas, Ogston-Luc, Czerny, Killian, Golovine, and others, have been proposed, and are being practised, for the treatment of frontal empyema. Uncomplicated cases can be cured by various ways of operating, as a study of the literature shows. It, however, must always be borne in mind that the lower wall of the frontal sinus is the one most apt to be affected, that perforation generally occurs through this wall, and that the adjoining cells of the ethmoid are frequently involved. ^ EntzUndliche Erkrankungen der Stirnhdhlen, 1895, p. 208 and following. ^ Die Naseneiterungen, 2d edition, 1896, p. 220.