. Manual of operative surgery. INFECTIONS OF MASTOID 41 With the curette, cautiously remove the cancellous bone from the suprameataltriangle in a direction parallel to the posterior wall of the bony meatus. Thiswill almost inevitably open the antrum. If the bone is much sclerosed, a smallgouge must be used instead of the curette. Having opened the antrum, exploreit thoroughly with a probe. With the curette, aided, if necessary, by rongeurforceps, remove all the external wall of the antrum. In the same mannerremove all the mastoid air-spaces. Every step in the removal of bone must bepreceded by
. Manual of operative surgery. INFECTIONS OF MASTOID 41 With the curette, cautiously remove the cancellous bone from the suprameataltriangle in a direction parallel to the posterior wall of the bony meatus. Thiswill almost inevitably open the antrum. If the bone is much sclerosed, a smallgouge must be used instead of the curette. Having opened the antrum, exploreit thoroughly with a probe. With the curette, aided, if necessary, by rongeurforceps, remove all the external wall of the antrum. In the same mannerremove all the mastoid air-spaces. Every step in the removal of bone must bepreceded by careful examination of the tissues to be removed; remember par-ticularly the normal site of the facial nerve (Fig. 34) and the normal, andparticularly the abnormal, course of the sigmoid Fig. 34.—^Left temporal bone. Antrum and most of the mastoid cells obliterated. I. Semicircular canals. 2. Location of facial nervein aqueduct of Fallopius, which has been opened. 3. Location of sigmoid sinus. The mastoid has now been converted into a comparatively shallow the walls of the pit carefully to see whether the disease process does ordoes not penetrate the cranial cavity. If the disease involves the sigmoid sinusor the meninges elsewhere, it must be attacked according to the principlesalready enunciated. In acute mastoiditis, after the antrum, etc., have been cleaned out, the in-flammation of the tympanum will promptly recede; hence it is unnecessary to usethe curette in the tympanic cavity (Whiting). This is fortunate, as otherwisemuch damage to hearing might easily be inflicted. In cases of chronic mastoid-itis and otitis the tympanum must be thoroughly opened and appropriatelytreated along the lines laid down on page 36 et seq. Step 5.—With rongeur forcep
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