Heilbrigðisskýrslur - 01.12.1963, Side 193

191 —
1963
packs were left in situ for a further three minutes and then the region of
the right nasofrontal duct was painted with 90% Cocaine. It was obvious
that he had a sub-mucous resection of his nasal septum very well carried
out and a right radical antrostomy. The intra-nasal opening is well forward
and as far down as possible and is still quite patent. A rather liberal portion
of the anterior ends of both middle turbinate bones had been removed but
this in itself is of no serious consequence. There were numerous adhesions
m the region of the right naso-frontal duct. These were removed with small
ethmoidal forceps and there after an S. shaped cannula passed into the
frontal sinus. The sinus was then washed out and the returning fluid was
quite clear.
I am of the opinion that this patient’s headaches are due to vacuum
smusitis secondary to closure by adhesions of the right frontal duct.
To have right extemal frontal operation and the application of Therisch
graft to the right naso-frontal duct under hypotensive anaesthesia.
Meantime put on Neophryn nasal spray Menthol Inhalations t.d.s. Sedate
tvith Nembutal orains 1 % note s.o.s.
15.1.59. To beve x-ary of chest, E.C.G., and kidney function test.
19.1.59. Under hypotensive anaesthesia an incision was made over the
floor of the right frontal sinus then passing medially and downwards medial
to the ethmoidal canthus over the lateral nasal bone. The periostium was
raised from the floor of the frontal sinus and the lateral nasal bone and the
orbit and its contents was retracted laterally and retained in that position
'with a Ferris-Smith retractor. The frontal sinus was then entered by chiping
away the bone over the medial part of the floor. This opening was widened
and a considerable portion of the lateral nasal bone was removed along
^th the maxillary process of the frontal bone. The anterior ethmoidal cells
^ore then removed and a frontal sinus rasp passed from the nasal cavity
toto the frontal sinus. A modified Foley’s Catheter was then passed through
ihe nasal cavity to the floor of the frontal sinus. A Theirsch graft was then
placed aroimd the upper end of the Catheter so as to lie in the naso-frontal
huct. The extemal wound was closed with a deep layer of intermpted catgut
suture and the skin wound was closed with atraumatic silk sutxn-e. The cuff
and the upper end of the Catheter was then inflated so as to approximate
the graft to the bone and mucosa in the region of the naso-frontal duct.
22.1.59. Wound dressed under general sedation. Dressings removed from
ihe eye and incision over the floor of the frontal sinus. Some oedema of the
nght upper eyelid and slight ptosis of the eye. This is due to intra-orbital
°edema. The Catheter was deflated and removed leaving the skin graft in
®!tu. No further dressings applied. To have Neophryn nasal spray t.d.s.
followed by Menthol Inhalations.
25.1.59. Stitches removed. Oedema of the right upper eyelid has subsided.
diplopia. Nose looks satisfactory on anterior rhinoscopy.