68 THE NOSE AND PARANASAL SINUSES
within the sinus. This may require to be got rid of by a proof puncture and
lavage of the sinus (see Fig. 32, p. 73). The operation should be performed
under general anaesthesia in acute cases. A trocar carrying a cannula is
introduced into the antrum by piercing the bone of the lateral nasal wall near
the roof of the inferior meatus where the wall is thinnest. The trocar is
withdrawn and pus may be aspirated through the cannula and sent for
bacteriological investigation and sensitivity tests. A Higginson's syringe is
then attached to the cannula and sterile saline solution at blood heat is
syringed into the antrum, the return flow passing through the ostium into
the nasal cavity and collected in a receiver. In some cases a fine polythene
tube is then passed into the sinus through the cannula which is withdrawn.
The tube is attached to the cheek by strapping and the sinus may be washed
out daily through it and a solution of the appropriate antibiotic instilled.
Should there be a dental cause for the acute maxillary sinusitis the dentist
may deal with the septic tooth under the antibiotic cover for the sinusitis.
When the sinusitis has been precipitated by a rupture of the antral floor
during a dental extraction the treatment is on conservative lines until the
acute stage has settled. In many cases the sinus between the antrum and the
alveolar margin will heal, but if not and if infection persists in the antrum
corrective surgery will be required (p. 85).
The ostium of the frontal sinus is favourably placed for drainage through
the nasofrontal duct. Sometimes the duct remains occluded in spite of
conservative therapy and in a few cases it may be necessary to open the
frontal sinus externally through a small incision below the medial end of the
eyebrow and to insert a drain into the sinus after making a small opening into
Acute ethmoidal and acute sphenoidal sinusitis rarely require any form of
surgical interference, but an orbital abscess following ethmoiditis will require
incision and drainage.
Short-wave diathermy should not be employed in the acute stage but is of
value in the subacute phase to give relief from discomfort, and combined
with decongestants to assist in drainage from the maxillary antrum.