Some remarks on naso-aural catarrh and its rational treatment / by John N. Mackenzie.

  • Mackenzie, John Noland, 1853-1925.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Some remarks on naso-aural catarrh and its rational treatment / by John N. Mackenzie. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    as follows: The patient.is seated in a tall, straight-hacked, narrow- seated chair, with the head thrown slightly back against the head rest (or supported by the arm of the operator). The surgeon, stand- ing at the side of the patient to be operated on, and elevating the tip of the nose with the thumb of the left hand, passes the wire loop, having the requisite diameter and curve, into the nostril. In this position the canula of the instrument will form an angle with the floor of the nostril varying with the curve of the loop, and its subse- quent passage into the nasal fossa will throw the shank of the instru- ment toward the median line. It should then be pushed slowly and gently backward and slightly downward, until the loop enters the naso-pharynx. Bearing in mind the distribution of the fifth nerve in the nostril, the snare should be kept as close as possible to the floor, hugging the inferior border of the septum, and avoiding as much as possible contact with the external wall. This not only facilitates its introduction, but lessens the tendency to reflex phe- nomena and painful sensation. The wire, being pliable, will adapt itself to the sinuosities of the nostril and pass the obstruction with- out difficulty. No force should be used; but if the canula be arrested, firm and gentle pressure will nearly always cause it to glide past the obstruction. The patient should be directed to keep his eyes open, and avoid facial contortions, which militate against the painless passage of the instrument. In cases where the fossa is more or less completely blocked, gradual dilatation with rubber bougies will materially aid the subsequent passage of the instrument. As the loop passes through the posterior nares over the bulge of the mus- cular palate, the contraction of the latter can sometimes be felt as it elevates the distal extremity of the wire. The wire should be pushed back until it reaches the posterior pharyngeal wall, and then gently withdrawn, care being taken to avoid the swollen lips of the Eustachian tube. The handle is then pressed slightly inward toward the septum as it is withdrawn. This will usually bring the loop over the hypertrophied mass. The distal extremity of the canula should now be pressed firmly against the turbinated bone, and the wire tightened by means of the screw. As the loop passes over the base of the palate, involuntary acts of deglutition sometimes occur, interfering with the adjustment of the wire. When the latter is properly placed, the presence of the growth within its grasp is easily recognized by the sense of resistance imparted to the finger in turning the screw. By this method the hypertrophied tissue may be
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