. The Journal of laryngology and otology. ce outside and its tip indicates the position of the burrin situ. 234 The Journal of Laryngology, [May, 1914. the size of the fronto-iiasal channel thus formed. Usually or 19 will enter, sometimes 19-23, or 19-25. (The figures givethe circumference in millimetres, hence, No. 19 has a diameterof 6 mm., or ^ inch. A 19-25 bougie measures 6 mm. in widthand 8 in antero-posterior diameter.) If such a large bougie willnot enter, the bone corresponding to the nasal crest may be shavedaway by the sliding cutting forceps till these large sizes can beintr
. The Journal of laryngology and otology. ce outside and its tip indicates the position of the burrin situ. 234 The Journal of Laryngology, [May, 1914. the size of the fronto-iiasal channel thus formed. Usually or 19 will enter, sometimes 19-23, or 19-25. (The figures givethe circumference in millimetres, hence, No. 19 has a diameterof 6 mm., or ^ inch. A 19-25 bougie measures 6 mm. in widthand 8 in antero-posterior diameter.) If such a large bougie willnot enter, the bone corresponding to the nasal crest may be shavedaway by the sliding cutting forceps till these large sizes can beintroduced, or the crest reduced first by the smaller guarded burr,or a small-sized sharp raspatory, till the passage admits the burror forcejDS. When a No. 10 enters the sinus the bony boss can beburred away with the 4 mm. guarded burr until it enters the sinus,Avhen it is made to burr the crest from above downwards. When the frontal sinus opening lies well to the outer side andtends to guide entering probes towards the orbital roof, unless. o o O O ^x^mm 6x8 mm Fig. S.—The avithors frontal sinus bougies, two thirds actual size; above, theround bougie, below, the swan-head ends. The sectional area of differentsizes are also shown. Assuming the normal fronto-nasal duct to be 2 , the passage of a 6 by 8 mm. bougie shows that the duct has been enlargedtAvelve times. contra-indicated by skiagrams it is well to draw the strong forcepsor burr towards the front so as to enlarge the frontal ostium to thefront and inwards rather than towards the orbital roof outwards. (6) With the small forceps Avhich now enter freely, the pi*o-jecting walls of any ethmoid cells which remain may be clippedawaj? to render the passage more free. (7) The sinus is well lavaged at this stage, and, finally theanterior end of the middle turbinal may be removed, as when it isleft intact the channel may be narrowed by subsequent with acute infection it may be safer to defer removi
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Keywords: ., bo, bookcentury1800, booksubjectear, booksubjectnose, bookyear1887
