Abscess of the orbit as the result of suppurating ethmoiditis : operation and radical cure / G. E. Schweinitz.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1897]
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Credit: Abscess of the orbit as the result of suppurating ethmoiditis : operation and radical cure / G. E. Schweinitz. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    of drainage, reference may be made to a ease reported by Adelheim2 of mucocele of the ethmoid cells, which underwent suppuration after accidental infection from the nose, thoroughly cured by an operation that opened the inner wall of the orbit, leading into the ethmoid cells, which were scraped out and the cavity drained by a T-formed tube, one part of which was brought out through the nose. Although it is not definitely stated, it is evident that the other portion of the tube came through the orbital opening. A second interesting and gratifying fact is the rapidity with which the tissues regained their normal functions. In less than three^months after the operation everything was solidly healed, even the small sinus which persisted and which led to the ethmoid sinuses having closed. In a case of extensive orbital involve- ment as the result of ethmoid disease, such as I have detailed, there is of course only one way to attack the affec- tion: that is, in the manner already de- scribed, by an operation through the or- bit. It is, however, also pertinent to urge, in the words of G-ruening,3 surgical pro- cedures from the orbit in cases of uncom- plicated empyema of the ethmoidal cells. In fact, as this surgeon states, it seems advisable to substitute more frequently the orbital for the intra-nasal operation, even in the earlier stages of purulent ethmoidi- tis, the evident advantages of this opera- tion being the possibility of direct inspec- tion and exploration of the ethmoid spaces, the greater facility of removing 2 Archives of Ophthalmology, New York, 1897, XXVI, pp. 142-143. 3 New York Eye and Ear Infirmary Reports, 1895, III, Part I, p. 21. granulations, polypi and carious bone, and the improved chances of securing drainage through the nose by perforating the floor of the ethmoid body. It is unnecessary in the present commu- nication to elaborate the ophthalmologic symptoms in general ethmoid disease. Those interested may consult with profit a paper on this subject by Dr. Thomas E. Pooley.4 To one class of cases, how- ever, I would like to call attention, name- ly, those of fistula of the orbit above the internal canthal ligament due to disease of the ethmoid. These have been de- scribed by Gruening,5 and he has effected a cure by forcing, with a strong probe, an opening through the base into the nasal cavity, thus facilitating drainage through the nose. In a recent case of this kind under my care, and by my re- quest also examined by Dr. Walter J. Freeman, the sinus is in exactly this posi- tion, or perhaps a little lower down, and through it a probe may be passed either into the anterior frontal cells, or else di- rectly into the ethmoid, and from the latter situation into the nasal cavity. Cases of this character have sometimes been mistaken for instances of lachrymal disease, and, in fact, they present some of the characteristics of the so-called pre- lachrymal abscess. The evident treat- ment, however, is the one recommended by G-ruening, or perhaps a more formal operation, in which the diseased area is exposed through a curved incision, the carious bone removed, and both external and intranasal drainage established. 4 The American Journal of Ophthalmology, St. Louis, 1897, XIV, pp. 100-106. . 5 New York Eye and Ear Infirmary Report?, Janu- ary, 1896. DISCUSSION. De. W. J. Freeman said that the reported case is especially interesting to rhino!ogists because of its probable origin in the eth- moid cells. Orbital abscess may occur with- out any direct connection with or infection from the ethmoid cells and an examination of this patient showed absolutely no sign of purulent ethmoiditis at the time he was first examined. There evidently had been in the past, trouble with the ethmoid cells, as was shown by perforation in the middle turbinals, where the cells had evidently en- larged and discharged by an abnormal open- ing into the fossse. There had been spontan- eous cure of the disease in a number of eth- moid cells, and probably also in the left su- perior maxillary sinus at the same time, the disease lingering in the cells near the orbit and finally rupturing into it. At the pres- ent time the lining of the superior maxil- lary sinus on the left is probably very thick, for the test by transmitted light shows it to be perfectly opaque. Chronic suppura- tive ethmoiditis is much more uncommon than many are willing to admit, and Dr. Freeman's experience is fully borne out by Bosworth's report in his new book in which he confesses seeing only five or six cases