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OPERATIVE SURGERY

OF THE

NOSE, THROAT, AND EAR



OPERATIVE SIJIWKRY



OF THE




FOR LARYNGOLOGISTS, KHINOLOGISTS, OTOLOGISTS,
AND SURGEONS



BY



v
HANAU W. LOEB, AM., M.D.

PROFESSOR OF EAR, NOSE AXD THROAT DISEASES IX ST. LOUIS UXIVERSITY

IN COLLABORATION WITH

Joseph C. Beck, M.D., George W. Crile, M.D., William II. ITaskin, M.D., Robert Levy, M.D.,
Harris P. Mosher, M.D., George L. Richards, M.D., George E/ Shambaugh, M.D.,
and George B. Wood, M.D.



IN TWO VOLUMES



VOL. II



FOUR HUNDRED AXD SEVENTY-SIX ILLUSTRATIONS



ST. LOUIS
C. V. MOSBY COMPANY

1917



vo \



COPYRIGHT, 1917.

(All Rights Reserved.)



Press of

C. V. Mosby Company
St. Louis



CONTRIBUTORS TO VOL. II.



JOSEPH C, BECK, M.D., CHICAGO.

Professor of Otology, Rhinoloyy and Laryngology, University of lilinc.i-

WILLIAM H. H ASK IX, M.D., NEW YORK.
ROBERT LEVY, M.D., DENVER.

Professor of Oto-Laryngology, University of Colorailo.

HAXAU W. LOEB, M.D., ST. Loi'is.

Professor of Ear. Xose and Throat Diseases, St. Louis University.

GEORGE L. RICHARDS. M.D.. FALL RIVER.



(v)



CON T K X T S .

(' II A PT H K V I I.

OPERATIVE STRGERY OF THE XASAL CAVITIES.

I'AGK

General Considerations 1

History Asepsis Position of the Patient Hospital Advantage-.

OPERATIVE SURGKRY OF T1LH SEPTUM XASI.

Submucous Resection of the Septum Nasi 4

Indications Contraindications Preparation I ncision Kle vat in 14 the Mucnperi-
chondrinm Incision Through the Cartilage Elevation of the Opposite Mucoperi-
cliondrium Removal of the Cartilage ;uid P>ono Dressing Af'ter-tieatment Com-
plications and Accidents.

Projection of the Anterior Portion of the Septal Cartilage 2'.'.

Other Operative Methods for Septal Deflections 24

The Saw Operation Removal by Chisels and Heavy Knives Trephine Asdi's
Operation Watson 's Operation Glcason 's Operation Roberts ' Operation SIu-
der's Operation Kyle's Operation Price-Brown's Operation Moure's Operation
The Oral Method of Resecting the Xasal Septum.

RESECTION OF THE INFERIOR AND MIDDLE TURP.INATES.

Resection of the Inferior Turbinate. , "0

Indications Contraindications Preparation Cutting Forceps and Scissors Sp"ke-
shave Bosworth Saw Cold Snare Beck 's Method- Ballenger Swivel-knife Sub-
mucous Method Freer 's Operation Yankauer ? s Operation Beck 's Cnchotribe
OperatioTi After-treatment Complications and Accidents.

Resection of the Middle Turbinate .':!'

Indications Contraindications Preparation Struyken 's Forceps Holmes ' Scis-
sors Submucous Resection Posterior Middle Turbinate ] 1 ypert i ophy After-treat-
ment Post-operative Accidents.

REMOVAL OF POLYPI.

Removal of Polypi 44

History Indications Contraindicat ions Preparation Sun re Forceps After-; reat-
ment.

OPERATIYE SURGERY OF THK ACCKSSORY CAVITIES OF THF, NOSF.
Operative Surgery of the Accessory Cavities of the Nose 4">

OPERATIVE SURGERY OF THE ETHMOID CKLLs.

Intrannsal Operations on the Ethmoid Cells

Indications Contraindications Preparation Curettement with Re>ectii>n nf the
Middle Turbiuate Hajek's Operntion Ballen.uer 's Operation- Sludei- 's (); eratinu
Luc 's Operation Mosher 's Operation Halle 's Operation After-treatment Re-
sults Serious Results Hemorrhage Orbital Cinnplicat ion<.

fvii)



Vlll CONTENTS.

PAGE
Extrair.isal Operations on the Ethmoid ............................................ 58

Operation Through tlio Frontal Operation Through the Maxillary.



OPERATIVE SURGERY OF THE FRONTAL MINI'S.

Intranasal Operations ........................................................... 59

I ml i rat ions Contra indications Preparation.
Operation ...................................................................... 62

Mother's Method lulls' Method Halle 's Method Halle's New Method Good's
Method After-treatment Results.
Extranasal Operations .......................................................... 67

Indications Preparation Ogston-Luc Operation Kuhnt 's Operation Luc's
Modification of Kuhnt 's Operation Taptas' Modification of Kuhnt 's Operation
Jansen's Operation Riedel's Operation Lothrop's Operation Killian's Operation
Knapp's Operation Hajek's Operation Beck's Osteoplastic Operation Results.

OPERATIVE SURGERY OF THE SPHENOID SINUS.

Genera] Considerations .......................................................... 81

History Indications Contraindications Anesthesia.
Opei at ions ..................................................................... S3

Enlargement of the Ostium Sphenoidale Resection of the Pars Nasalis Hajek's

Operation Sluder's Operation- -Operation Tlirough the Frontal Operation Through

the Maxillary Results of Sphenoid Operations.

OPERATIVE SURGERY OF THE MAXILLARY SINUS.

General Considerations .......................................................... 91

History Indications Contraindications.
Puncture Through the Nasal Wall ................................................ 92

Resection of the Nasal Wall ...................................................... 95

Preparation Simple Resection of the Nasal Wall Through the Inferior Meatus

Operation Through the Middle and Inferior Meatus Dahmer's Nasal Flap Method
Cantii'ld's Operation Skillern 's Operation Results of Intranasal Operations on

1 he Maxillarv Sinus.
Oral Operations on the Maxillary Sinus ............................................. 10(5

Operation Tlirough the Alveolus Kiister's Opei-ation Cald\vell-Luc Operation

Denver's Operation -Heck's Obliterating Operation Partsrh's Operation After-

treat mcnt of Oral Operations on the Maxillarv Sinus - Result s.

Mlsr|-:i.l.AN,:ors MINOR OPKRATIONS WITHIN THK NOSK.

Synechia ....................................................................... 114

............................................. 115

............................................ . 116

............................................. 116

Operations on the Larnmal Sac .................................................. 118

History We.-t '< Operation Halle's Operation - Polyak's Operation- Choronsliit/,-
kv's JVrrnnaliciilii r J'linctine of the Tear Sac Wiener and Sailer's Operation
Mosher's Operation Yankauer's Opernt ion - -l.erk 's Operation- Results.

Injection of the Spheiiopalatini 1 (Innglion ......................................... 129

Indication* Operation Results.




CONTENTS. IX

OPERATIVE SURGERY OF THE II YPOP1I YSIS, BY WAY OF THE NOSH AND ITS

ACCESSORY CA V IT I KS.

PACK

Indications ]''}

Operation l.'il!

Eisclsl tore's Operation Halstead 's Operation Fra/.ier 's Opera t ion Cushiny's
Operation Kanavel 's Operation Hirsch 7 s Operat ion Heck 's Operat ion.

MAJOR OPERATIVE SURGKRY OF THE NASAL CAVITIES.

General Considerations H-

Indications Contraindications Anesthesia.
Resection of the Xasal Walls IK!

Moure's Operation Preysin<;'s Operation- Denker 's Extended Operation.
Temporary Resection of the Nose 1-17

Oilier 's Method Gussenbauor 's Method Chassignac-Bruns Method Lanyenbeck 's

Method.
Excision of the Maxilla M!)

Removal of Bone Removal of Palate and Alveolar Process Preparation Incision

Removal of Bone Completion of Operation Results.
Resection of the Palate 1.3(i

CHAPTER VIII.

OPERATIVE SURGERY OF THE PHARYNX.
ADENOIDS.

General Considerations ]5 ( .)

History General Conditions Indicating Removal Anesthesia Preliminaries In-
strumentarium.

Operation KJ4

Operation with Forceps Operation with Curette Operation with the Adenotome
After-treatment Recurrence Complications Results Mouth-breathing after the
Operation.

OPERATIVE SURGERY' OF THE TONSILS.

Minor Local Procedures 1 7i>

Galvanocautery Incision of the Crypts with a Knife- Crypt Forceps Punch
Forceps.

Removal of Tonsils 1 7l!

Indications Contraindications Choice of Operation Blond Supply of the Tonsil
Preparation for Operation Local Anesthesia Place of Operation General Anes-
thesia Position Instrumentarium Suction Apparatus.

Tonsillotomy ]S4

Snare Operation.

Tonsillectomy ] S(i

Tonsillectomy by Finyer Dissection Yankauer's Method- Loeb 's Method -Sluder 's
Method of Tonsillectomy Modifications of Sluder 's Method In-ei'soll's Method
The Method in Common Use in the Boston Hospitals: Ether Anesthesia: Erect
Position West's Method Dissection with Scissors Galvanocautery Dissection
Complications After-treatment.



X CONTEXTS.

PERITOXSILLAK ABSCESS.

PAGE

Operation 212

Preparation First Point of Incision Second Point of Incision After-treatment-
Complications Results.

GRANULAR PHARYNX (FOLLICULAR PHARYNGITIS).
Galvanocautery 215

RETROPHARYNGEAL ABSCESS.

Operation 215

Instruments Position After-treatment Accidents and Complications.

PHARYNGOMYCOSIS.
Pharyngomycosis 216

ELONGATED OR HYPERTROPHIED UVULA.

Operation 216

Indications Contraindications Anesthesia Instruments Operation After-treat-
ment Complications Bifid Uvula.

EDEMA OF THE UVULA.
Edema of the Uvula 218

ADHESIONS OF THE SOFT PALATE TO THE PHARYNX.

Retropharyngeal Adhesions 218

Instruments Operation Roe's Operation Operation of Nichols Mackenty's Oper-
ation Obturator Other Methods Final Results.

HYPERTROPHY OF THE LINGUAL TONSIL.

Lingual Tonsillotomy 225

Complications After-treatment.

FIBROMA OF THE NASOPHARYNX.

General Considerat ions 2126

I ndi cat ions Contraindications Prognosis Anesthesia.
Operation 227

Evulsion by tlir Lange Method Hinsberg's Operation Electrolysis After-treat-
ment Com pi i cat ions.

BKNIGX GROWTHS IX THE PHARYNX.



Benign Growths in the Phary

Angioma of the Velum Cysts LipornaPapilloma and Fibroma Teratorna
Angioma and Lymphangioma of the Pharynx Lymphoma, Lymphadenoma, and
Myoma.

MALIGNANT DISEASES OF THE PHARYNX.

Malignant Diseases of the Pharynx 2.T1

Carcinoma Sarcoma Treatment.



CONTEXTS. XI

(' II A PT KK I X.

ENDOLARYNGEAL OPERATIONS WITH THK AID OF THE

LARYNGOSCOPE.

REQUISITES AND AIDS.

PAGE

Requisites and Aids l'.'!7

Anesthesia 1:40

Local Anesthesia Local Anesthesia l>v Injoctioii into the Superior Laryngeal Nerve
General Anesthesia.

MINOR OPERATIONS.

Puncture Scarification Incision 245

Indications Puncture Scarification Incision Anesthesia Technic After-treat-
ment Value of Operation.

Curettage 24s

Indications Contraindications Anesthesia Technic After-treatment.

Electrolysis 24!*

Indications Technic.

Galvanocautery 24!

Indications Anesthesia Technic After-treatment Untoward Effects.

TUMORS.

The Laryngoscopic Method 25.'!

Benign and Malignant Tumors 254

Benign Tumors '255

Chemical Caustics Galvanocautery Electrolysis The Sponge Method of Voltolini
Incision Forceps The- Galvanocautery Snare The Cold Wire Snare The Guil-
lotine.

Malignant Tumors '_!7I

Tumors of the Trachea 27'!

Operative Methods.

LARYNGEAL TUBERCULOSIS.
Operations 274

Galvanocautery Incision and Scarification Submucous Injection Curettage and
Excision Curettage Excision Removal of Epiglott is Electrolysis.

Stenosis of the Larynx 2S(i

Intubation Dilatation.

C II A P T E R X.
OPERATIONS ON THE EXTERNAL EAR AND THROUGH THE CANAL.

General Considerations 291

Instruments Preparation of Field Anesthesia.

AURICLE.

Auricle 296

Tumors Hematomata or Othematomata Perichondritis.



XI 1 CONTEXTS.

OPERATIONS IN THE CANAL.

PAGE

Operations in the Canal LM>7

Tumors Grumilomata Furunculosis.

MEMHRANA TYMPAN I .
Myringotomy or Paraeentesis 2!)!)

General Considerations Indications Anesthesia Tec-lime.
Removal of Drum Membrane to Improve the Hearing 1501

Accidents, Results, and Complications.
Simple Myringotomy .'>()!

Ossiculectomy :\0'2

Indications Anesthesia Operation.

Curettage of the Isthmus of the Eustachian Tube .'107

Value of the Operation.

C H A P T E R X I.

SURGERY OF THE MASTOID PROCESS.

WILDE'S INCISION.



Indications
Operation



SIMPLE MASTOID OPERATION.

Indicat ions .'ill

Pain Swelling of the Soft Parts Over the Mastoid Process Sinking in of the
Posterior or Superior Wall Persistence of Copious Discharge and .Pain Sudden
Cessation of Discharge with Continuance or Accession of Pain Swelling of the
Posterior Cervical Lymph-Nodes Roentgenographie Evidences - ! nfective Agent
Meningeal Symptoms Fever P>lood Picture General Tndisposit ion.

Cunt raindicat ions .'!15

Opera t ion .'!] li

Preparation of Patient Shaving of Scalp Cleansing Application of lodin Anes-
thesia Local Anesthesia. Tnstriimenlarium Light Hone Relat ions Assistants
Incision Elevation of the Periosteum Retraction of the Soft Parts Landmarks
The Excntcral ion of the Hone Primary Treatment of Wound and Dressing The
Hlood Clot Method- Postauricular Drainage Mel hod - A fter-1 rent meiit .

Complications .'Ill

RADICAL MASTOID OPERATION.

1 1 i -tui y Purpose of t lie Opera) ion ."> 41

Indications )!41

Anile Suppurations Chronic Suppurations.

Con) i aindicat ions

Operation

Operative Field Prcoperative Procedures Preliminary Details Membranous Canal
- Removal of the Posterior Hony C;inal Removal of the Ossicles The Manage-
ment of the Kustachian Tube Plastic Fhips Skin Grafting Dressing Operation
Without Flaps After-treatment.

Conijilic.il ions . .'!.")(>



CONTENTS. XI 11

MODIFICATIONS OF RADICAL MASTOID OPERATIONS.

PAGE

Heath Operation

Indications Operation.



Bondy Operation

Stacke Operation

.Simple Mastoid Operation Suggested liy Phillips

Murphy 's Method

Ossiculectomy and Removal of the Lateral Attic Wall as Proposed l>y Neumann
Procedures to Facilitate Resolution..



5 ft



THROMBOSIS OF THE LATERAL SINUS, THE .JUGULAR P.ULB, AND THE
INTERNAL .JUGULAR VEIN.

Indications '',01

Fever Chills, Nausea and Vomiting Other Pycmic Symptoms Condition of the
Sinus Wall Positive Findings in Aspiration of the Sinus Edema in the Posterior
Portion of the Mastoid Region and Tenderness on Percussion Over the Sinus Cord-
like Feeling of the Jugular Vein Symptomatic and Artificial Papillitis Blood
Examination Roentgenograpliic Evidence Contraindications Jugular Ligation in
Lateral Sinus Thrombosis.

Operation for Lateral Sinus Thrombosis ;',05

Ligation of the Internal Jugular Vein .",<;ii

After-treatment.

OPERATIVE SURGERY OF THE LABYRINTH.

General Considerations 'I"' 1

History Indications.
Operations '!"!'

Hinsberg 's Operation Jansen-Xeumann Operation Richards ' Operation Beck 's

Operation After-treatment.

OPERATIVE SURGERY OF MENINGITIS OF AURAL OR NASAL ORIGIN.

Indications 'i^- '

Types of Meningitis Earlv Signs and Symptoms Intermediate Symptoms Ter-
minal Symptoms Prognosis.

Spinal Puncture '' s -t

Operation.

Drainage of the Cisterna Magna -"> V

Crockett 's Method >'.

Puncture of the Corpus Callosum '! S S>

BRAIN ABSCESS OF AURAL AND NASAL ORIGIN.

Indications ">S'l

Pain Pulse Rate Fundus Oculi Focal Symptoms Spinal Puncture Ext radural
Abscess Pathologic Manifestations Localization.

Operation "!'5

Temporosphenoidal Abscess Cerebellar Abscess Brain Abscess in Other Locations
Beck's Operation on the Prefrontal Lobe Results and Accidents.



ILLUSTRATIONS.

FK;. i'.u;i:

410. Mask for covering the face

411. Position of patient on table

412. Application of cocain to the vicinity of the nerve trunks 7

413. llefi'ernan speculum

414. Incisions for submucous resection 9

415. Freer 's knife 10

416. Freer 's elevator in

417. Ha.jek-Ballenger's elevator (blunt) In

41S. Killian 's elevator 10

419. Hunl 's elevator in

420. Elevating the mucoperichondrium 11

421. Ballenger 's knife 12

422. Killian 's speculum 12

4215. Foster-Ballenger 's speculum 12

424. Foster-Ballenger 's speculum in position K!

425. Ballenger 's swivel-knife ~\'.'>

426. Method of using Ballenger's s\vivel-knife 14

427-42S. Method of using Ballenger's swivel-knife with Killian speculum 14

429-4.'50. Method of using Ballenger's swivel-knife with Foster-Ballenger 's speculum 15

431. Appearance of septum after removal of cartilage 15

432. Removal of bone 16

433. Briinings ' forceps .1 <i

434. Knight 's forceps 16

435. Killian 's forceps 17

43(5. Freer-Griinwald 's forceps 17

437. Removal of nasal crest 1 s

43S. Hajek 's chisel 1 ^

439. Ballenger 's chisel 1 ^

440. Introducing the needle lit

441. Tying the knot 19

442. Freer 's submucous instruments 20

443. Freer 's incision 21

444. Todd's splint 21

445. Bosworth 's saw operation 24

446. Bosworth 's saw 25

447. Xichols ' spokeshave 25

448. Moure 's spokeshave 25

449. Asch 's scissors 25

450. Fracture of septum after use of Asch 's scissors 26

451. Mayer 's splint 26

452. Kyle 's splint 26

453. Gloason 's operation 27

454. Incisions for Shuler 's operation 2^

455. Incisions for Sluder 's operation 2^

456. Sluder 's operation. Fragments placed in position

457. Fetterolf 's wedge-shaped rasp

458. Moure 's operation

459. Kretschmann 's method

(XV)



XVI ILLUSTRATIONS.

FIG. PAGE

460. Struyken 's forceps 31

461. Eesccting inferior turbinate with Struyken 's forceps 31

462. Beckmann 's serrated scissors 32

463. Hermann 's scissors 32

464. Seiler 's nasal scissors 32

465. Jackson 's turbinotome 32

466. Resection of inferior turbinate with the saw 33

467. Eesection of the posterior end of the inferior turbinate by the cold snare.... 34

468. Beck 's operation with guide for snare 35

469. Beck 's clip introducer 35

470. Ballenger's method of resecting the inferior turbinate with the swivel-knife. . 36

471. Freer 's instruments for resecting the inferior turbinate 37

472. Beck 's conchotribe 3$

473. Showing visible portion of the external wall of the nose on inspection 40

474. Operation with Struyken 's forceps 40

475. Operation with Struyken 's forceps 41

476. Holmes ' scissors 42

477. Eesection of middle turbinate with Holmes' scissors 42

47$. Submucous resection of the middle turbinate 43

479. Andrews ' turbinate chisel 43

480. Hajek 's hooks 43

481. Removal of polypi. Smaller drawing shows how the ethmoid cells may be

exenterated after the removal of polypi 45

482. Xasal snares 40

4.83. Griinwald 's cutting forceps 48

484. Myles ' cutting forceps 49

485. firiinwald-Kummel 's cutting forceps 49

4.86. Lermovex 's cutting forceps 49

487. Jaekson-Dabney 's cutting forceps 49

48,8. Xasal curettes 50

1 S 9. Clearing out the ethmoid cells with forceps 51

490. Fxenterat ion of ethmoid cells with hook 51

491. Ballenger's ethmoid knife 52

492. Mosher's ethmoid operation- Curette entering the upper overhang 53

493. Steps of Mosher's ethmoid operation 53

49 L Incision in Halle 's ethmoid operation 55

495. Flap in Halle's ethmoid operation 55

490. Cleaning out ethmoid cells with forceps in Halle 's operat ion 50

497. Clearing out ethmoid cells \vif h curette in Halle 's opera t ion 50

498. Replacement of middle turbinate and flap in Halle's ethmoid operat ;"u 57

199. Sound introduced into the frontal sinus through an orifice in the floor 00

500. Sound introduced into the frontal sinus through the infundibiiluni 01

5d ]. Ingals' frontal sinus operation 03

502. I ngals ' frontal sinus d rain age t ubc 03

50.'!. Halle's frontal sinus operation. Introducing the pointed frontal dental drill

through the floor of the frontal sinus in front of the protector 01

501. Halle's frontal sinus operation. Enlargement of the opening with the pe;ir

shaped burr 04

Halle's new frontal sinus operation. Introducing the probe 05

Halle's new frontal sinus operation completed 00

(rood 's frontal sinus opera) ion 07

Bone removed in Ogston- Luc 's operation on the frontal Os

Bone removed in Kuhnt 's operation on the frontal OS



ILLUSTRATIONS. XV11



,110. Bone removed in T:ipt:is' modification of Kuhnt's operation on the frontal.... (is

HI!, Bone removed in Killian 's operation on the front;il ........................ (is

512. Bone removed in .Tansen 's operation on the frontal ........................ (ill

513. Bone removed in Ifiedel's operation on the frontal ......................... 09

514. Lothrop's operation on the frontal sinus. Relative amount of hone removed 71

515. Lothrop's operation on the frontal sinus, showing the removal of the inter-

frontal septum, nasal spine and perpendicular plate ...................... 72

51G. Lothrop 's operation, front view .......................................... 71'

517. Killian 's operation on the frontal sinus. Incision closed with interrupted

sutures ............................................................... 73

518. Killian 's operation. Incisions through periosteum .......................... 1\

519. Killian 's operation. Elevation of the periosteum .......................... 75

520. Killian 's frontal sinus chisel .............................................. 75

521. Killian 's operation.. Removing the inferior wall ........................... 7'!



522. Hajek 's operation. Incision 7S

523. Hajek 's operation. Bone flap 7s

524. Beck 's operation. Groove to guide the Gigli saw 7!)

525. Beck 's operation. Formation of bone flap 80

520. Andrew ' sphenoid sound 82

527. Faraci 's forceps s.''.

528. Hajek-Skillern 's punch forceps

529. Fletcher-Anderson 's punch forceps 83

530. Grayson 's hand burr 84

531. Enlargement of the ostiuni sphenoidale 84

532. Enlargement of the ostiuni sphcnoidale; flap used to cover lower margin of

the opening s.->

Hajek 's operation on the sphenoid

Sluder's knife: middle turbinate knife; sphenoid knife

Binder's sphenoid operation. Resecting the anterior third of the middle tur-
binate S7

Sluder's sphenoid operation. Middle turbinate severed from its attachment.. ^7

Sluder's sphenoid operation. Resection of the ethmoid capsule

Sluder's sphenoid operation. Knife penetrating the anterior wall 89

Sluder's sphenoid operation. Method of making the three cuts through the
anterior wall of the sphenoid and the posterior ethmoid cells. Knife intro-
duced for cutting through the pars nasalis 89

540. Sluder's sphenoid operation. Position of the cuts made in the anterior wall

of the sphenoid 90

541. Lichtwitz's antruni needle 92

542. Fein 's antrum needle 92

543. Introducing Lichtwitz's hollow needle into the inaxillary sinus 93

544. Introducing Lichtwitz's hollow needle into the maxillary sinus 94

545. Introducing curved hollow needle into the maxillary sinus 94

546. Pierce 's antrum trochar 95

547. Fletcher 's antrum trochar 95

548. Killian 's antrum trochar 95

549. Welhelmenski 's antrum trochar 90

550. Penetrating the nasal wall of the ant rum 90

551. Tilley's antrum burr 97

552. Wagner 's antrum punch 97

553. Ostrom 's antrum punch 97

554. Spies ' antrum punch 97

555. Yankauer 's antruni punch 98



XV111 ILLUSTRATIONS.

FIG. PAGE

556. Fletcher 's antriun punch 98

557. Removal of the nasal wall of the maxillary sinus with Wagner's punch forceps 98

558. Vail 's saw 99

559. Dental engine and Halle 's handpiece with burrs 99

560. Removal of nasal wall of maxillary sinus with Struyken's forceps and curette

without disturbing the inferior turbinate 100

561. Operation through middle and inferior meatus 100

502. Dahmer's method of using a nasal flap for the floor of the maxillary sinus. ... 101

5(53. Dahmer 's method diagrammatically shown 101

504. Canfield 's operation. Incision 103

505. Canfield 's operation. Elevating the periosteum and soft parts from the facial

surface and from the nasal wall of the maxillary sinus 103

5(50. Canfield 's operation. Diagrammatic illustration of using the flap from the

nasal wall 104

507. Canfield 's operation completed 105

508. Operation through the alveolus 107

509. Caldwell-Luc operation on the maxillary sinus. Incision 108

570. Caldwell-Luc operation. Chiseling the facial surface of the maxillary 109

571. Caldwell-Luc operation. Bone removal completed 109

572. Caldwell-Luc operation. Xasal wall removed 110

573. Bone removal in the Caldwell-Luc operation Ill

574. Bone removal in the Dcnker operation Ill

575. Bone removal in the Canfield operation Ill

570. Bone removal in the Beck operation Ill

577-582. Partsch 's operation 11.'!

583. Removal of synechia with Struyken 's forceps 114

5s4. Author's operation. Splint in position 115

585. Yankauer 's needles and appliances for nasal suture 117

580. West 's operation. Formation of flap 118

587. West's operation. Method of chiseling through the torus lacrimalis without

flap formation 119

5S8. West's operation. Cutting away the nasal wall of the lacrimal sac 119

589. West's operation. Establishing a permanent opening by the use of three

small flaps

590. (Jreen 's operation

591. West 's instruments for the lacrimal operation



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