Evaluation of Roentgen Therapy in Sinus Disease

Abstract

ALTHOUGH the medical men in ancient times did not have the same conception and understanding of the nasal sinuses that we have to-day, they did make references to conditions which, in the light of our present knowledge, can be interpreted as sinus disease. Since Albright (1) has thoroughly covered the history of sinus disease from antiquity to the present time, it is sufficient to say here that until 1850 our modern knowledge and conception of sinus disease were unborn. From the period of 1850 until 1900, rapid steps were made in the understanding of the anatomy of the bones of the face and of the paranasal sinuses. In this period the names of Caldwell and Luc (23) came into prominence. Caldwell advised making an opening through the canine fossa and a counter-opening through the inferior meatus. The primary opening was allowed to close and treatment was carried on through the opening in the meatus. In 1903, Luc described a similar approach and advised complete removal of the lining membranes. The accomplishments of these men marked the beginning of radical nasal surgery which reached its height about 1915. Surgeons and rhinologists of this era from 1850 until 1915 were attempting to relieve the pathology in the accessory sinuses by surgical procedures, that is, by attempting to modify the anatomy of the accessory nasal sinuses. Their byword was drainage, drainage, and more drainage. When their surgical procedures failed, more radical ones were advised in an attempt to turn failure into success by more surgery. The end-results in most instances, however, were most unfavorable. The adage grew, and was true, that sinus surgery—once performed—required sinus surgery from then on. About 1913 there began a metamorphosis from the radical opinion held by the rhinologists to one of conservatism. Pathology in the accessory sinuses was being studied in an attempt to explain their diseases. The consistent failure of the radical procedures forced the surgeons to turn to physiology and biology for an explanation of “why the surgery failed.” The consensus of opinion of the more conservative, better trained men in otolaryngology is expressed by the following quotation from Wright (23): “The period of my activity, covering as it does more than 25 years, witnessed the absurd exaggeration of notions as to the frequency when sinus disease required surgical intervention and the rash resort to this devastating destruction of nasal structures in operative measures designed to afford relief to affections more or less trifling in themselves. It experienced the disappointment of too enthusiastic operators and too credulous patients. It saw reputations, world-wide in the domain of our specialty, made out of a manual dexterity perhaps, but also an intrepidity of spirit which often approached too much upon the rights of humanity and too often disregarded the precepts of conscientious professional contacts.”