Transactions . on was found in the nose. Itwas impossible to decide whether this was due to an operationor to disease. There was no pus in the nose. Operation in this case was done as in the previous one. Inthis instance, however, the eyebrow was shaved first and conse-quently there was some difficulty in following the line of thebrow, and the incision was made too low. It was found that the swelling was caused by air, and thatwe had to deal with a pneumatocele of the frontal sinus causedby caries sicca. The frontal bone was diseased by caries. Here,as in the other case, the rim of the orbit w
Transactions . on was found in the nose. Itwas impossible to decide whether this was due to an operationor to disease. There was no pus in the nose. Operation in this case was done as in the previous one. Inthis instance, however, the eyebrow was shaved first and conse-quently there was some difficulty in following the line of thebrow, and the incision was made too low. It was found that the swelling was caused by air, and thatwe had to deal with a pneumatocele of the frontal sinus causedby caries sicca. The frontal bone was diseased by caries. Here,as in the other case, the rim of the orbit was preserved, but thewhole anterior wall of the frontal sinus, the roof of the orbit,and the superior nasal process of the maxillary bone was removed,and the naso-frontal duct was sufficiently enlarged to establishfree drainage. The mucous membrane in the frontal sinus wasfound everywhere detached, thickened, and rolled upon itself, themass filling the naso-frontal duct. Final result shown in photo-graph No. Fig. II. Discussion. 237 DISCUSSION. Dr. T. R. Pooley, New York: I have done several operationsof this sort and the only way in which my method differs fromthat of Dr. Gruening is that I introduced a drainage tube, afterthe curettement of the frontal and ethmoidal sinuses, into thenose and closed the wound completely, the drainage tube beingsubsequently removed through the nose. The cases did very think the modification that Dr. Gruening thinks so good, theremoval of the nasal process of the superior maxillary bone, maydo away with the necessity for the drainage tube. One thing I should like to ask Dr. Gruening; in cases ofevident disease of these accessory sinuses, where the diagnosiscan be made from the purulent discharge from the nose, butwhere there are not these eye symptoms, no diplopia, proptosis,etc., whether to relieve the headache we are warranted in makingthis external operation? I have seen it done in several instancesand the results were not satisfac
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