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TRANSILLUMIXATION : ITS FALLACY AS A DLAGXOSTIC MEANS IX DISEASES OF THE MAXILLARY AND FRONTAL SINUSES- By L. B. LOCKAED, M. D., TOLEDO. OHIO. In a paper recently read before the Western Oph- thalmologieal, Otological, Laryngological, and Ehino- logical Association the following statements were made: " Transillumination is by some considered unim- peachable. While my experience with it has so far been satisfactory, yet I can see how it might lead one into error. " Ordinarily, when the sinus shows dark, we will find pus, or at least a greatly thickened mucosa; but let us run briefly over the possibilities: if the sinus shows clear, it means one of two things — it is either healthy or contains a mucocele; if clearer than its fellow, it does contain a mucocele, unless the other sinus be diseased, absent, or contains a solid neoplasm. " If it shows dark, the sinus contains pus or has a thickened mucosa, unless it be a solid neoplasm or the sinus absent and its place occupied by a part of the frontal lobe of the brain" (Sampson). Under Empyema of the Frontal Sinuses, in Bur- nett's System, we read: " A valuable aid to the diagnosis is transillumination. If the sinus is in a state of health it becomes illuminated as high as the superciliary Nizagara Tablets ridge, while if it should contain fluid it would remain dark." In regard to maxillary disease, the writer says: " In case pus or a solid tumor be present in the antrum, that side of the face remains dark, while the opposite is brightly illuminated. In case of cysts of the sinus it becomes much more brilliantly illuminated than the opposite side." Such are, to-day, the almost universally accepted conclusions in regard to the results obtained by trans- illumination — conclusions which I beheve to be Buy Nizagara entirely unwarranted as well as dangerous. Unwarranted, be- cause well-known anatomical conditions preclude the possibility of accuracy; dangerous, because the uncer- tain results obtained may lead to incorrect diagnoses and consequent uncalled-for operative procedures. That such morbid processes produce such results I admit, but I deny that these results, when obtained, can be Buy Nizagara Online attributed to such diseased conditions. The purport of this paper is to outline briefly the most important atypical anatomical conditions, with their effect upon the transmission of light. The variations in and the differences between normal pneiunatic spaces, not alone in different individuals, but also upon opposite sides of the same, are no less pro- noimced and characteristic than those occurring in the cranium and face. These variations in form and size Nizagara Online are so frequent Order Nizagara and pronounced that it is almost impossible to choose any one as the typical. All are normal and represent merely different de- grees in the extent of the resorptive process that hol- lows out these cavities from the compact bone. The normal typical maxillary sinus can be likened to a three-sided pyramid, these sides being known as the orbital, facial, and temporal. Of the three sides the thinnest is the orbital, the strongest and thickest the facial. In men the floor of the antrum lies on a level with the floor of the nasal cavities, while in women it is situated somewhat higher. The cavity, however, that adheres to the typical is 738 /. OKA RD : TEA NSILL TJMINA TION. [S. Y. Med. Joue., an exception, some one or more of the following forms being usually present: (a) The floor of the antrum lies on a plane inferior to that of the nasal cavities. This condition is due to excessive resorption of the

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