Greenfield Sluder

XLVIII. Some Anatomic and Clinical Relations of the Sphenoid Sinus to the Cavernous Sinus and the Third, Fourth, Fifth, Sixth and Vidian Nerves

The body of the sphenoid bone is usually hollowed out by the sphenoidal sinus. This cell may, however (rarely), be rudimentary and occupy a very small space in the lower anterior part of the body, which is otherwise hollowed out by a postethmoidal cell. It is of the cell which hollows the body of the sphenoid that I speak, regardless of whether it be the sphenoidal sinus proper or a postethmoidal cell. The body of the sphenoid is covered above and laterally by the dura mater, with the cavernous sinus between its external and internal surfaces (in it), occupying a position for the most part above and lateral to the body. Within the cavernous sinus are found the internal carotid artery and the third, fourth and sixth cranial nerves, with the first division of the fifth lying in the lower part of its lateral wall. The impression given in the treatises on anatomy is, usually, that these nerves are rather widely separated from the sphenoid sinus, as shown in Figure 1. The .second and third divisions of the fifth and the Vidian are also usually represented as well removed from this cell-that is, separated by a considerable thickness of bone. (Fig. 1.) The fact is, the sixth and the third division of the fifth are the only ones of these nerves that are not at times in close association with this cell-that is, separated from it by a very thin layer of bone; and even the third division of the fifth is sometimes also it). rather close

XVII. A Surgical Consideration of the Upper Paranasal Cells

I propose a surgical procedure for the upper paranasal cells which cuts downward and forward. All other procedures, so far as I know, cut more or less upward and backward. Anatomically the paranasal cells are designated according to which meatus of the nose they enter. This is more or less an anterior and posterior subdivision, and for the purposes of diagnosis this must remain unchanged. For surgical purposes, however, it seems to me that they may advantageously be thought of as upper and lower, the latter being the antrum of Highmore, the former being the remaining cells. This subdivision establishes a horizontal. dividing line on the lateral wall at about its middle. Successful surgery of the antrum must leave a drain at the lev.el of the nasal floor. The lower-