The surgical treatment of orbital complications in disease of the nasal accessory sinuses / by Arnold Knapp.

  • Knapp, Arnold Herman, 1869-1956.
Date:
[1908]
Catalogue details

Licence: In copyright

Credit: The surgical treatment of orbital complications in disease of the nasal accessory sinuses / by Arnold Knapp. 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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    access is given to the roof and to the inner wall of the orbit (Fig. 2). The pulle}^ of the superior oblique is carefully de- tached from the trochlear fossa. It is important not to disturb the relation between the tendinous ring through which the tendon passes and the periosteum to which it is adherent; the periosteum later becomes attached in its normal position by the healing process and interference with the superior oblique muscle is avoided. • This im- portant relation can best be preserved by dislodging the pulley from the trochlear fossa b)^ a blunt periosteotome working from behind forward. An examination of one hundred skulls has shown mc that in four out of five Fig. 2.—Cotnplele detacliiuent of the orbital contents and removal of floor of frontal sinus and of internal orbital wall. the pulley is attached to merely a slight depression in the bone; in the remainder a well-developed spine di- rected straight down and occasionally slightly forward, was present just posterior to this fossa. It is .evident that in the cases in which a spine is present the perios- teum with the pulley can only be sparingly detached by following the above-described procedure. The entire floor of the frontal sinus is then easily re- moved with the chisel and hammer, the diseased mucous membrane is curetted and the bony septa in the frontal sinus are carefully eradicated. A portion of the orbital margin can be removed without causing any deformity if the normal curve be preserved. The nasal process of