Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . too low. The cranial cavity may be entered through the roof of the tympanum if the roof of the inner end of the meatus is cut too high. It is for these reasons that the an-trum should be opened early and thenthe well between the antrum and themiddle ear cavity cut away until a freecommunication is secured (Fig. 1009).A good view is then obtained. Theossicles may be removed, and roughedges of bone smoothed. An occa-sional packing with adrenalin gauzewill control th
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . too low. The cranial cavity may be entered through the roof of the tympanum if the roof of the inner end of the meatus is cut too high. It is for these reasons that the an-trum should be opened early and thenthe well between the antrum and themiddle ear cavity cut away until a freecommunication is secured (Fig. 1009).A good view is then obtained. Theossicles may be removed, and roughedges of bone smoothed. An occa-sional packing with adrenalin gauzewill control the bleeding. All necroticareas should be curetted. There are certain precautions to beobserved. As the wall between theantrum and tympanum is cut away the roof of the semicircular canals comes in view. The facial nerve lies just belowthe horizontal semicircular canal, whence it passes backward, downward andoutward to its exit. It passes close to the meatal canal in its inner and pos-terior wall. The inner third of the posterior wall of the meatus must beapproached with care; its upper third may be cut away, but its lower two-. Fig. 1009.—Mastoid antrum has been exposed and itsouter wall removed. The wall between theantrum and external auditory canal is beingremoved. The inside of the mastoid cavityis left smooth and even. 314 SURGICAL TREATMENT thirds should slope upward and inward to the roof of the horizontal semicir-cular canal. The floor of the middle ear is slightly lower than that of themeatus; the step should be removed with the sharp curet. Here the domeof the bulb of the jugular vein rises in the floor of the tympanum. It mayencroach upon the meatus. Care should be taken to avoid it. If wounded,gauze packing controls the bleeding. The carotid artery may be woundedby careless curetting of the Eustachian tube. The upper end of the Eustachian tube should be closed by curetting itsorifice. The disease may be found confined to the middle ear alone. Com-monly
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
