A METHOD OF CLOSING A SINUS BETWEEN THE ANTRUM OF HIGHMORE AND THE MOUTH
Journal of the American Medical Association (JAMA)
Chicago: It seems to me that our duty lies in the direction of doing all we can to place persons who are thus afflicted in the hands of those who are eminently prepared to correct' the defect. Other defects, aside from stammering come into our experiences in the management of those who are not able to speak distinctly. For a long time 1 have been trying to help these persons by directing them to experts in phonation. Such teachers as Dr. Kenyon, Dr. Iludson-Makueii of Philadelphia, Dr.
... lphia, Dr. Scripture of New York and Mrs. Heed of Detroit are able to do so much to assist those afflicted in this way, help them out of their difficulties and put them in a position to go through life as others do, that 1 feel that we should recommend these persons to them for treatment. Dr. A. T. Rasmussen, La Crosse, Wis. : 1 devote a good deal of time to the practice of facial orthopedia, commonly known ¡is orthodontiu. A case comes to my mind of a bright boy, 15 years old, whose parents brought him to me stating that he stuttered, and asking that, if possible, 1 lind a reason for it. They said that he stuttered seldom, but that when he did, it was very bad. There seemed nothing wrong about the boy's condition except some slight oral defects. I performed an oral operation, correcting a slightly undeveloped maxilla, and gave the boy a great, many suggestions. He dovs not stammer now. Whether it was altogether the suggestion, or whether it was the Heal incut, or whether it, was a combination of the two, 1 am not prepared to say, but, 1 think that we should take into consideration the possibility of this defect being due to some pathologic condition in the mouth. Mrs. Frank Reed, Detroit: I think, that the gentleman who has just spoken has made it quite clear to us that any physical defects which are present should be corrected, and that possibly such correction would give the child.u suggestion that he can talk all right when he has learned the process of speech. Dr. 11. F. MoBeath, Milwaukee, Wis.: Dr. Kenyon and Mrs. Reed have made clear to you the disadvantages to the individual stammerer, and Dr. Brophy makes the suggestion that they be sent to eminently able people for correction. Knowing the number of stammerers in this country, we see that but a small fraction can be handled by the few who an-capable of doing the work. What is needed by the schools is an outline of the principles which should be followed so that the teachers shall not be permitted to continue experimenting, In twenty-six cities in the United States the number of stammerers in the schools is not, even known. In twelve cities the schools are attempting to do this work and arc getting good results through their special teachers. Nearly all of the school superintendents from different parts of the country in answering my questionnaire express themselves as seeing the need in the near future of establish ing a department for the stammerer. H seems to me that the American Medical Association might outline a superior method which would he a great help to these educators. Underweight Schoolchildren.-In one of the public schools in Philadelphia, Walter W. Roach found that ten pupils between (i and 7 years of age were ti2 pounds underweight, or an average (i I/o pounds per child; eighteen pupils between 7 and 8 years were lit) pounds underweight, or an average 7 il/ni pounds per child; fifteen pupils between o and 10 years were 93 pounds underweight, or an average ti 1/5 pounds I'll child: sixteen pupils between 10 and II years were l(i."> pounds underweight, or un average in l/:i pounds per child; Six pupils between 11 and 12 years were 58 pounds under. Weight, or ¡in average 11% pounds per child; twelve pupils ol l.'l to 1-1 years were 1(17 pounds underweight, or an average 14 pounds per child. The topic with which this paper deals has been chosen for three reasons: first, because I have had so much difficulty myself in eradicating these sinuses; second, because I see so many sinuses left after others have operated; and, third, because a search of the literature has failed to furnish very much information regarding the technic of such a procedure. Since selecting the topic I have operated in twenty-three such cases. They were all cases of alveolar necrosis with antrum involvement, with the exception of two cases, or they were cases of permanent sinus following an operation for antrum suppuration secondary to alveolar necrosis. The two exceptions were, first, a large infected dentigerous cyst, lying external to the antrum. This was drained into the nose through the antrum. And, second, a case of composite follicular odontoma which was also drained into the antrum and through it into the nose. With the cases of alveolar necrosis and Highmorian empyema a Denker operation with the complete removal of the necrotic bone was performed. Various methods for closing these sinuses were tried. Those tried at First gave uniformly bad results. The perfected operation gave about ninety-live per cent. good results. I will describe simply the technic of that part of the operation which was performed after completing the Denker oper at i on, and also the various methods attempted in the order in which they were tried. First, I removed the necrotic bone and then the inferior portion of the alveolar process. Just enough of the latter was removed to bring the periosteum of its inner and outer surfaces together. The two layers of periosteum were then sutured with interrupted sutures of black Chinese silk, No. 4. These sutures did not hold but tore out within a few days notwithstanding the fact that they were carefully cleansed every two hours with hydrogen peroxid. Second, the periosteal llaps were prepared the same as before, and, using the same silk, by means of doubleanned suture's the threads were introduced from within out, just above the bone. These sutures held better than the first but tore out in two or three days. It was now manifest that the Chinese silk was not the proper substance l'or siilure material. It would become soaked with saliva, swell, and naturally become crowded with micro-organisms. It was quite impossible lo keep these sutures clean. Third, silk-worm gut was substituted for Chinese silkas in thé second method. These sutures could be kept clean and held several days longer than the others, hid not long enough to secure healing. The silk-worm gul would enl through the mucous membrane and the periosteum. Fourth, various substances as gauze, pieces of rubber lube, lead plaies, etc., were placed within the loop of silkworm gut, on the inner surface of (he alveolar process and a second piece placed underneath the outer ends before they «ere sutured. This was done with (he hope of preventing the sutures from cutting through the membrane and periosteum. The pieces of gauze which