Sometimes the pain is referred also to the region of the antrum of Highmore and to the Eustachian tube and the middle ear.
When the local symptoms are unusually severe and the discharge abundant, it is probable that inflammation has in some cases extended to the antrum of Highmore.
Not only do deflection of septum and hypertrophy of the nasal bones occur, but the antrum (cavity behind the nose) may be almost entirely obliterated, while the upper jaw is arrested (Fig.
Von Langenbeck of Berlin mentions an instance of fracture of the superior maxilla, in which the eyeball was so much displaced as to lodge in the antrum of Highmore.
The suppurative process, after having produced an erosion and the perforation of the orbital plane, had reached by propagation the antrum of Highmore, whence the pus took its way, issuing through the nose.
Two years later he published his treatise on the diseases of Highmore’s antrum and on fractures and caries of the maxillary bone.
The natural opening of theantrum being reëstablished, one irrigates the cavity through it by means of a cannula to which a small syringe has been screwed.
Flajani[314] chose to see in this case a precocious example of the opening of Highmore’s antrum through the alveolus.
He speaks at length of the anatomy of the maxillary sinus, of its relation to the teeth situated below it, of the various modes in which the diseases of the antrum are produced, of their symptoms and treatment.
Bell contradicts the opinion of Jourdain and Hunter that the morbid gatherings of Highmore’s antrum are generally consequent upon the closing of the normal opening of the cavity in the middle meatus.
To facilitate the exit of pathological humors from the sinus, after the Cowper operation, he introduced a small cannula, forked at one end, into the antrum and fixed the two branches of the fork to the neighboring teeth by tying.
When the teeth situated below the antrum have fallen out, or have been extracted some time, and their alveoli are in consequence obliterated, it will be better to have recourse to Lamorier’s method.
He recommends perforating theantrum immediately above the first molars, or rather between it and the malar bone.
Some writers speak of the antrum as the part most seriously affected; but I cannot find any thing corresponding to the antrum in the horse's head.
An alveolar abscess deeply seated in the maxilla may open into the maxillary antrum and set up suppuration in that cavity.
Mastoid pain and tenderness are indicative of inflammation in the antrumor cells, and when these symptoms supervene in the course of a chronic middle-ear suppuration, they should always be regarded as of grave import.
Acute suppuration may occur in the mastoid cells in the course of an attack of acute otitis media, or as a result of interference with drainage in chronic suppuration of the antrum and middle ear.
Suppuration in the Tympanic Antrum and Mastoid Cells#, or Acute Suppurative Mastoiditis.
As a rule, however, it is necessary to expose the interior of the antrum by opening through the mastoid cells--Schwartze's operation.
If the posterior wall or roof of the antrum is destroyed, intra-cranial complications are liable to ensue.
On the other hand, the mastoid and antrum may be exposed from within outwards by removing the outer attic wall and working backwards (Stacke’s operation).
If there be difficulty in exposing the antrum in the performance of the radical operation owing to the lateral sinus projecting far forwards and the middle intracranial fossa overlapping it externally.
If a profuse otorrhœa has continued for over four weeks and is accompanied by sagging downwards of the upper posterior wall of the external meatus, a definite sign that the antrum is involved.
This is an operation for gaining access to the maxillary antrum and the lower part of the nasal cavity on the same side.
If this be done systematically, infected cells may be found some distance away from the antrum itself, although an area of apparently healthy bone lies between them and the antrum.
The opening should allow of the surgeon’s little finger passing freely from the antrum into the floor of the nose, and vice versa (Fig.
This may be necessary if the anterior wall of the antrum and mastoid process be affected.
For puncturing the maxillary antrum from the nose.
The antrum and mastoid cavity are then thoroughly examined.
If there be acute middle-ear suppuration; (ii) if the perforation be very small, as there will be a considerable risk of the fluid being driven into the mastoid antrum and further infecting it.
With each successive stroke, begun a little more posterior and inferior to the one preceding it, more bone is removed until at length the antrum is exposed.
With it any opening is probed carefully to see whether it is merely a mastoid cell, or dura mater covering the outer wall of the lateral sinus, or the middle cranial fossa, or if indeed it is the antrum itself.
At the same time there is no doubt that complete recovery takes place in a certain number of cases in which the antrum has not been opened.
Illustration] Inflammation of the antrum maxillare is occasionally met with; but the surgeon is more frequently called upon to treat the consequences of this action in it.
In general the discharge gradually diminishes, the membrane of the antrum resumes its healthy condition and functions, and the aperture in its parietes is shut by a fine ligamentous substance.
Unless active and early measures are taken to subdue the inflammatory attack, the antrum becomes distended by increased and vitiated discharge from its lining membrane.
When seated in theantrum maxillare, pain is experienced in the cheek for a short time before swelling occurs.
The membrane covering the small aperture through which the antrum and nostril communicate partakes of the general thickening, and thus no outlet is left for the accumulating fluid.
In short, the antrum maxillare is occasionally the seat of chronic, as well as of acute abscess.
It is undertaken for the removal of tumours of the antrum and of the alveolar margins, in all which cases the section for its removal must be made through healthy bone, and wide of the disease, so as to insure that the whole is removed.
