Operative surgery, for students and practitioners . e bone, upward, awayfrom the supra-orbital incision, thus denuding the surface of bonecorresponding to the anterior wall of the frontal sinus, and doAvn-ward, away from the lower periosteal incision, denuding the bonecorresponding to the inner part of the roof of the orbit. The peri-osteum covering the bridge of bone which it is proposed to leave tosupport the soft parts is thus left undisturbed. The front wall ofthe sinus is penetrated with a chisel and mallet, and a considerableopening made with the rongeur bone-forceps. The mucous membrane
Operative surgery, for students and practitioners . e bone, upward, awayfrom the supra-orbital incision, thus denuding the surface of bonecorresponding to the anterior wall of the frontal sinus, and doAvn-ward, away from the lower periosteal incision, denuding the bonecorresponding to the inner part of the roof of the orbit. The peri-osteum covering the bridge of bone which it is proposed to leave tosupport the soft parts is thus left undisturbed. The front wall ofthe sinus is penetrated with a chisel and mallet, and a considerableopening made with the rongeur bone-forceps. The mucous membranelining of the sinus is freely incised—it is at times found very muchthickened—and the sinus is thus entered. The interior of the sinusis explored with the probe to discover its dimensions, extent, etc., andthen the entire contents removed with the sharp curette. The floorof the sinus is perforated with the chisel and mallet, and the entirefloor of the sinus then gouged away with the rongeur forceps, working TREPHINING OF THE FRONTAL SINUS. 103. Fig. 65.—Frontal Sinus. Right Side, Simple Operation; Left Side, KillianOperation. Shows bridge of bone. Probe is passed under bridge of bone throughIrom opening in frontal sinus into orbit. 104 HEAD AND FACE. toward the front and downward and sacrificing the frontal processof the superior maxillary bone. The anterior ethmoidal cells arethus freel}^ uncovered and may be curetted if diseased, and a largeopening established into the nasal cavity for the purpose of operation may be continued farther if conditions warrant, break-ing down of all the ethmoidal cells, removal of the middle turbinate,and opening and curettage of the sphenoidal sinus. A biting bone-forceps of the Griining type is used, and gTeat care must be exercisedin using the curette and other instruments—especially not to per-forate the cribriform plate of the ethmoid or the roof of the sphenoidalsinus. The posterior cranial wall of the frontal sinus may
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