A field surgery pocket book : memoranda mainly based on experience in the present war / prepared under the direction of the Director General of Army Medical Services.

Date:
1944
Catalogue details

Licence: Public Domain Mark

Credit: A field surgery pocket book : memoranda mainly based on experience in the present war / prepared under the direction of the Director General of Army Medical Services. Source: Wellcome Collection.

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    When the sinus contains pieces of metal or fragments of bone it must be opened by the sub-labial route, cleaned out and counter drainage provided into the inferior meatus of the nose. In some cases of fracture, particularly when there is depression of the floor of the orbit, it may be necessary to pack the antrum for seven to twenty-one days with sulphonamide gauze in order to retain the fragments in position. Depressions of the malar or zygomatic arch without an external wound should be elevated as soon as possible. Most can be reduced with a lever introduced between the temporal muscle and temporal fascia through an incision within the hair line over the temporal fossa. Others can be replaced by grasping the fragment through the skin with stout tenaculum forceps and manipulating with the aid of a finger in the mouth high up behind the bucco-labial sulcus. In some, particularly late cases, a combined Caldwell-Luc and temporal approach is often required followed by a suspension by wires attached to a bracket embedded in a plaster headcap. In severe deformities with loss of bone, replacement by an iliac bone graft will be necessary. The Frontal Sinus. : Injuries of the forehead involving the frontal sinus require cosmetic repair and functional restoration. An external approach is necessary. All loose fragments of bone and blood clot must be removed from the sinus which is then drained into the nose by a rubber tube surrounded by Thiersch graft. Where there is moderate destruction of the anterior bony wall the lumen of the sinus may be restored by a larger skin graft in the form of a sac, held in position by a bag of oiled silk packed with ribbon auze. Z When the posterior wall of the frontal sinus is fractured and the dura torn, repair of the dura by a fascia lata graft is necessary and the case should be transferred at once to the care of a neuro-surgeon. This is also required for fractures involving the ethmoid and followed by cerebro- spinal rhinorrhoea. The Ethmoidal Labyrinth. Operation in this region after injury should be avoided if possible. Explorations for foreign bodies should be postponed for fourteen days at least, and approach should be by the external route. Earlier surgical clearance may be necessary if infection is present. Sulphonamide therapy should be employed early. If obstruction of the fronto-nasal duct is likely a skin graft must be inserted. Aviation Sinusitis. . Sudden alterations of barometric pressure produce definite changes in the paranasal sinuses. The symptoms are acute pain referred to the region of the affected sinus and sometimes syncope. Within the sinus small petechial haemorrhages may be seen in the lining, submucous haematoma may form or haemorrhage occur into the cavity of the sinus. In severe cases the mucosa may be torn from the walls of the sinus. fio Treatment must be conservative. Rest, sedatives, inhalations of menthol and the instillation of 1 per cent. ephedrine in normal saline into the nose. Amyl nitrite is efficacious in some cases. Infection seldom occurs if interference is avoided. Should acute suppuration supervene a simple intranasal drainage must be performed.