A manual of otology for students and practitioners . und, does not allow the point of the curette to slipand do damage. The thumb near the end of the instru-ment enables one to use great force safely. Another goodmethod is to place the spoon of the instrument beneathany projecting edge of a cell wall and remove the partsin an outward direction by using the upper marginof the bone wound as a fulcrum. The side of the bowlbeing toward the sinus and the force exerted outward,this structure is safe. Some force may be used in ananterior direction toward the posterior canal wall. If,as the cells are
A manual of otology for students and practitioners . und, does not allow the point of the curette to slipand do damage. The thumb near the end of the instru-ment enables one to use great force safely. Another goodmethod is to place the spoon of the instrument beneathany projecting edge of a cell wall and remove the partsin an outward direction by using the upper marginof the bone wound as a fulcrum. The side of the bowlbeing toward the sinus and the force exerted outward,this structure is safe. Some force may be used in ananterior direction toward the posterior canal wall. If,as the cells are being removed, working upward, the sinus15 226 MASTOIDITIS is accidentally exposed, or if there is a perisinus abscess,it is best to do the work around the antrum and in theother parts of the bone and come back to the region ofthe exposure at the end of the operation. The reason forthis is that if the sinus is wounded it renders the restof the operation more difficult, so it is advisable to post-pone any danger of this accident until the end of the. Fig. 72.—One method of using the curette while removing mastoid cells. operation. If no sinus exposure occurs, the cells areremoved from the sinus plate behind to the posteriorwall of the canal in front. If in doing this, there is anoverhanging cortex, it may be taken away with therongeur or large-sized gouge. Considerable variationin the mode of removing cells is not only allowable, butalso advisable. The operator should study each manipu-lation which his ingenuity suggests in order to determine MASTOID OPERATION 227 that neither the sinus nor dura are endangered. Espe-cially if a small curette is used, no force should be exertedin the direction of these structures, as the bone betweenthe instrument and them may be thinner or less firmthan it was believed to be and the instrument may easilypenetrate them, perhaps carrying in its bowl much infec-tious material. A large-sized curette may be used toremove rough projections from the
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Keywords: ., boo, bookcentury1900, bookdecade1910, booksubjectear, bookyear1916
