Using X-ray films taken of skull of Japanese in 3 directions, measurements of the visual angle and field obtained with various operative sinus were taken to determine the suitbility of the different approaches. The purpose of the measurements taken on the X-ray films of the skulls was to provide numerical values for comparison of the extent of exposure afforded by the different routes of approach to the ethmoid cells. The visual angle and field of exposure afforded by these 3 main routes, that is, the intranasal, extranasal and intraoral routes, were studied on the basis of measurements taken on the X-ray film of the skull specimens. Many methods have been described for operation of paranasal sinusitis but they can be roughly divided into 3 maintypes according to the route of approach to the ethmoid cells. Operative Routes Evaluated on the Basis of Roentgenologic Study. In some instances, projections of the optic foramen were also taken. Each picture was taken under identical conditions. The axial projection in this study was in the direction parallel to the cribriform plate and perpendicular to the line connecting the inion and nasaion, the center of the beam passing through the hypophysis. Projections were made in the lateral, posterior-anterior and axial directions.įor the posterior-anterior porjection, Gonda's method of nasion-inion projection in which the central bean of X-rays passes in the direction of the inion through the nasion was employed. In a similar manner, wire coils were inserted from the anterior and posterior ethmoidal foramen in the inner wall of the orbit, and landmarks were placed at the anterior nasal spine, foramen of the infra-orbital canal and rhinion. Using the wire ligatures employed by dentists to fasten artificial crowns, wire coils conforming in shape, length and diameter to the optic foramen in each of the skulls were made and inserted into the canals.Ĭare was taken so that the ends of the metal coils did not project the orbital fossa or the cranial cavity. Skulls of Japanese with intact bony structures of the face, consisting of 100 males and females each, were procured for this study. It was therefore considered worthwhile to evaluated the various routes for operation of the ethmoid cells as the angle of vision and the field of exposure provided by the different routes would influence the execution of the surgical procedure and help in avoiding damage to the above structures. In view of the seriousness of such complications, any means by which damage to these areas during operation could be avoided or lessened would be highly desirable.

The use of antibiotics has lessened the dangers of intracranial complications but injury of the optic nerve is still a matter of grave consequence. Two serious complications associated with radical operation of chronic disorders of the paranasal sinuses are intracranial damage and injury to the optic nerve. No data were available as to indicate the presence of specific protein in the nasal secretion as studied by reactions between human serum and anti-nasal secretion rabbit serum or nasal secretion and anti-nasal secretion rabbit seum. The above five proteins were likewise proved in reactions between nasal secretion and antinasal secretion rabbit serum.Ħ. All the five proteins, albumin, haptoglobin, transferrin, IgA, and IgG were identified in almost all postoperative cases of chronic sinusitis.ĥ. Haptoglobin and transferrin were often missing in so-called unstable stage of chronic sinusitis.Ĥ. Serous secretion always contained all of the five proteins.ģ. Watery nasal secretion and mucoid nasal secretion were often found to lack haptoglobin and transferrin, while mucopurulent or purulent discharge also lacked haptoglobin and transferrin but less frequently.

Nasal secretion contained albumin, haptoglobin, transferrin, IgA and IgG.Ģ. The results of the immunoelectrophoresis of nasal secretion may be summarized as follows ġ. The nasal secretion obtained carefully excluding blood component was centrifuged to determine the protein concentration and then studied by means of immunoelectrophoresis. The two different antiserums, antihuman serum rabbit serum and anti-nasal secretion rabbit serum, were prepared to analyze the protein in the nasal secretion.Įach fraction of protein was identified according to Quchtherlony's method, thereby comparisons were made among the nasal secretions obtained in various diseases of the nasoparanasal diseases. Human nasal secretion was studied by means of immunoelectrophoresis in order to compare the same to the serum and to investigate distribution of protein fraction in various nasoparanasal diseases.

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