. Manual of operative surgery. floor of the sinus, leaving the orbital margin intact for cosmetic 6.—Resect the frontal process of the superior maxilla and the rest ofthe floor of the sinus. Step 7.—Resect the anterior and middle ethmoidal cells and the respectiveparts of the middle turbinal. These structures are always affected. Step 8.—Close the wound after providing for drainage by a rubber extensive removal of the floor of the sinus and consequent opening of theorbit cannot be without danger. The inevitable entrance of pyogenic organismsinto the non-resistant fatty ti
. Manual of operative surgery. floor of the sinus, leaving the orbital margin intact for cosmetic 6.—Resect the frontal process of the superior maxilla and the rest ofthe floor of the sinus. Step 7.—Resect the anterior and middle ethmoidal cells and the respectiveparts of the middle turbinal. These structures are always affected. Step 8.—Close the wound after providing for drainage by a rubber extensive removal of the floor of the sinus and consequent opening of theorbit cannot be without danger. The inevitable entrance of pyogenic organismsinto the non-resistant fatty tissues must often give rise to orbital abscess. Earths Operation.—A little to the side of the middle at the root of thenose make a longitudinal incision i inch in length, down to the bone. Witha chisel carry the above incision through the nasal process of the frontal boneand the nasal bone. At the upper and lower angles of the wound, by means of anarrow chisel, make horizontal cuts outwards through the bone. The flap of. INJECTIONS IN TIC 59 bone thus formed is pried outwards (Fig. 43) like a trap-door with hinge placedexternally. The upper part of the opening is filled with the mucous membraneof the frontal sinus. Cut through this bulging mucous membrane. Throughthe above opening diseased tissue may be inspected and removed, free drainagethrough the nose may be provided, and if necessary the opposite sinus may beopened and treated. When the operation is completed, the bone flap is restoredto place and the vertical skin-incision is sutured. CHAPTER IVTIC DOULOUREUX In severe cases of trigeminal neuralgia, after treatment by medicine andby removal of sources of peripheral irritation and particularly of infectionhas failed, operation offers the only hope of amelioration or cure. Very manyoperations have been devised, but not all of them are useful. The earliestoperations consisted in the subcutaneous or open division of the nervetrunks as they left or entered their bony ca
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