Nasal Cavity In Patients Research Articles

The Impact of Unilateral Concha Bullosa on Mucociliary Activity: An Assessment by Rhinoscintigraphy

In this study, we aimed to compare the differences of nasal mucociliary clearance rate (NMCR) by rhinoscintigraphic examination between the nasal cavities of patients with unilateral concha bullosa (CB). The study group consisted of 43 patients (18 men and 25 women), with unilateral CB ranging in age from 20 to 58 years (mean age, 33.5 ± 9.51 years). The nasal mucociliary clearance was described as the velocity (mm/min) of nasal mucociliary transport of the technetium 99m-macroaggragated albumin droplet. Rhinoscintigraphy was performed on each nasal cavity with 2-day intervals in the patients. The mucociliary clearance rates obtained in the unaffected side were accepted as control values. The average values for mucociliary clearance rate were 2.29 ± 0.42 mm/min in the CB side of the nasal cavity, and 3.19 ± 0.52 mm/min in the other side of the nasal cavity. Mucociliary transport took a longer time in the CB side of the nasal cavity than in the other side of the nasal cavity, which was found to be statistically significant (p < 0.001). Our study showed that unilateral CB might impair NMCR in the ipsilateral side of the nasal cavity. Thus surgical intervention to reduce the middle concha volume may result in a better mucociliary clearance with possibly a less chance of development of chronic sinus diseases and nasal pathologies. Obviously, it is of utmost importance that new studies be planned with larger patient series to better understand nasal mucociliary transport mechanism and CB relationships.

A prospective study of bacterial flora in nasal cavity of patients with persistent allergic rhinitis

It remains unanswered whether persistent allergic inflammation in nasal mucosa alters bacterial colonization and infection. The aim of this study was to investigate the bacterial flora in the nasal cavity of patients with persistent allergic rhinitis (PAR) and to correlate the bacteriological findings with presence of nasal symptoms, nasal eosinophil and neutrophil counts. A total of 255 subjects, aged between 6 - 74 years (mean 33.9 years) was randomly selected from a population-based rhinitis survey study in Singapore. All subjects went through a thorough medical history and nasal examinations. Serum specific IgE to a panel of common house dust mites, nasal cytological and microbiological examinations were performed. PAR was diagnosed in 107 patients and none of them had received previous regular therapy. There is a significant relationship between PAR and eosinophil grades, but not with neutrophil count. No statistically significant difference was found in quantitative and qualitative bacterial flora in nasal cavity between PAR patients and subjects with non-rhinitis or with non-allergic rhinitis. There is a significant inverse correlation between ongoing rhinorrhoea and quantitative bacterial load, and between signs of nasal mucosa (pale and edema) and the presence and type of bacterial pathogens. In conclusion, our study demonstrates that patients with untreated (or using PRN medicine) PAR do not result in a significant change in bacterial flora in their nasal cavity.

The Use of an In Vitro-cultured Porcine Nasal Mucosa Model for the Biocompatibility Assessment of Biodegradable Magnesium

The development of an in vitro-cultured porcine nasal mucosa model is described. The model was subsequently used for the biocompatibility testing of resorbable magnesium-based implants, which are intended for use in the nasal cavity of patients with chronic rhinosinusitis (CRS). Test specimens made from either pure magnesium or titanium were incubated with the mucosal tissue for 48 hours. Afterwards, tissue viability, PGE2, IL-6 and IL-8 release, magnesium ion release, succinate dehydrogenase activity, apoptosis and 14C amino acid incorporation, were determined. The results suggested favourable biocompatibility, even in the case of rapidly-degrading pure magnesium. However, presumed effects on protein synthesis and apoptosis could not be confirmed.

Investigation on the Structure of Nasal Cavity and Its Airflow Field in Crouzon Syndrome

Setup computational fluid dynamics (CFD) model of the nasal cavity in patients with Crouzon syndrome analyze inspiratory airflow hydrokinetics of its nasal cavity. After changing the morphosis structure of the nasal cavity by operation, compare the preoperative and postoperative alteration of the airflow field of the nasal cavity and evaluate the effect of operation on the physiological function of nasal ventilation. Eleven patients with Crouzon syndrome were underwent spiral computed tomographic laminar scanning to obtain DICOM data and establish the CFD model. The field features of the nasal cavity with inspiratory static state phase were simulated and analyzed by the Fluent software. The changed data on preoperative and postoperative flow field in the nasal cavity in 5 of 11 patients were compared and analyzed. The nasal cavity of a patient with Crouzon syndrome reflected the structural features of relatively short and high-vaulted anteroposterior diameter. The nasal valve was the narrowest region in the nasal cavity and was the key region of producing obvious pressure drop. The inspiratory static state phase reflected comparatively high local airflow rate (approximately 2.469 m/s) and sheer force of the nasal wall. With the distance increasing from the anterior naris, the pressure inside the nasal cavity was decreased gradually. The pressure drop in the nasal cavity before the front end of the concha nasalis inferior (approximately 2 cm from anterior naris) accounted for most of the pressure of the whole nasal cavity (69%-88% of the overall pressure in nasal cavity and 79.24% on average). Osteotomy advancement and distraction osteogenesis increased the anteroposterior diameter of the nasal cavity and the changed nasal resistance. By analyzing the structure of the nasal cavity of patients with Crouzon syndrome and the CFD numerical simulation of patients after the procedure, airflow distribution in patients' nasal cavity and the effect of the surgery on the structure of the nasal cavity and airflow field were realized. Nasal valve played a pivotal role in the airflow field distribution of the nasal cavity. Operation changed the nasal resistance, improved the ventilation of nasal cavity, but did not affect the airflow field distribution of nasal cavity.

Nasal colonization of symptomatic pneumonia patients in University of Benin Teaching Hospital, Benin City, Nigeria by multiple antibiotic resistant Staphylococcus aureus

A study of the antibiotic resistance pattern of Staphylococcus aureus from the nasal cavities of patients with pneumonia attending the University of Benin Teaching Hospital, Benin City, Nigeria was conducted. The survey revealed S. aureus to be the most predominant cause of Staphylococcal pneumonia with an occurrence rate of 38.5%. Other microorganisms encountered includedStaphylococcus epididermis , Streptococcus viridans and Brahamella catarrhalis . Patients in age group 1 - 5 years had the highest incidence rate of 60 and 53.8% in males and females, respectively, while patients within ages 11 - 30 years had the least incidence. There was no significant difference between the rate of occurrence of staphylococcal preumonia in males and females at p > 0.05. High resistance levels was recorded towards tetracycline (100%), chloramphenicol (95%), erythromycin (85%) and ampicillin (80%) while moderate resistance levels was recorded towards saprfloxacin (60%), ciprofloxacin (45%), gentamycin (40%) and ofloxacin (20%). The observation in the study, calls for need for effective surveillance of antibiotic resistance. Key words: Antibiotic resistance, Staphylococcus aureus, nasal cavities, pneumonia

Accuracy of acoustic rhinometry versus computed tomography in the evaluation of nasal cavity in patients with nasal polyposis

Acoustic rhinometry (AR) accuracy in the diagnosis and follow-up of nasal polyps is as yet unclear. Our objective was to study its accuracy compared with computed tomography (CT) in patients with nasal polyps. We studied 29 patients diagnosed of nasal polyposis by nasal endoscopy. In all patients sinunasal CT-scan, AR and nasal nitric oxide (NO) were assessed. Nasal volumes between 0 and 5 (V(0-5)) and 5 and 9 (V(5-9)) centimetres from nasal inlet were measured with AR and CT-scan, by using Pearson and intraclass correlation coefficient tests. All patients (29,79% males, mean age 48.2 yr [range 34-61]) had nasal polyps (score 2-3 on Lildholdt classification, score 0-3). Measurements (right plus left sides) were: AR 8.9 +/- 0.8 cm(3) (V(0-5)) and 15.5 +/- 3.6 cm(3)(V(5-9)); CT 6.5 +/- 0.4 cm(3) (V(0-5)) and 6.3 +/- 0.8 cm(3) (V(5-9)). Pearson correlation was r = 0.67 (p < 0.01) for V(0-5) and r = 0.62 (p < 0.05) for V(5-9). Intraclass correlation coefficient test was 0.51 (V(0-5)) and 0.28 (V(5-9)) for consistency; and 0.43 (V(0-5)) and 0.23 (V(5-9)) for absolute agreement. Low levels of NO (312.3 +/- 43.8 ppb) were found and the correlation between NO levels and volumes (V(0-5) or V(0-9)) measured by AR was not statistically significant. Compared to CT-scan, AR measurements accurately reflect the geometry of nasal cavity volumes in patients with nasal polyps, with a better assessment in the anterior part of the nasal cavity.

Effects of surgically assisted rapid maxillary expansion on nasal dimensions using acoustic rhinometry

The objective of this study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal dimensions using acoustic rhinometry. Twenty-seven patients ranging in age from 18 to 53 years were evaluated as having a maxillary transverse deficiency larger than 7 mm, a bilateral cross-bite, and no evidence of nasal obstruction. All patients underwent evaluation of the nasal cavity by acoustic rhinometry both before and 6 months after SARME. The Wilcoxon test was used to evaluate minor cross-sectional areas (MCA) and the nasal volume of the right and left nasal cavities, and these parameters were measured with and without the application of topical nasal decongestant before and after SARME. In comparison with preoperative measurements, minor cross-sectional areas and nasal volumes were significantly larger after SARME. There was a statistically significant difference associated with the use of nasal decongestant; the minor cross-sectional areas and nasal volume of the right and left nasal cavities were smaller when nasal decongestants were not used. Surgically assisted rapid maxillary expansion increases the minor cross-sectional areas and volume of the nasal cavities. Acoustic rhinometry is an objective method for evaluating the geometry of the nasal cavity in patients with transverse maxillary deficiency.

The Role of Superantigens in Chronic Rhinosinusitis with Nasal Polyps

Recent reports suggest that staphylococcal exotoxins, acting as superantigens, activate T cells with subsequent massive proliferation, thereby contributing to the etiology of chronic rhinosinusitis with nasal polyps (CRSwNP). The objectives of this study are (1) to demonstrate directly the presence of staphylococcal exotoxins in nasal mucosa and sinonasal polyp tissue, and (2) provide indirect evidence of the effect of superantigens on the T cells expressing the target of superantigen, i.e., the β variable chain receptor (TCRBV) in polyp tissue and peripheral blood of patients with CRSwNP. Sinonasal polyp tissue and peripheral blood specimens were obtained from 37 patients with chronic rhinosinusitis (22 patients with bilateral nasal polyps, 15 without nasal polyps) and 12 normal subjects for comparative negative controls. Tissue specimens were assayed by enzyme-linked immunosorbent assay (ELISA) for the most common staphylococcal exotoxins (A–D) and toxic shock syndrome toxin type 1. Fresh tissue and blood samples were analyzed by flow cytometry to determine the expression of TCRBV. In the CRSwNP subjects 12 of 22 samples (54.54%) demonstrated reactivity for at least 1 staphylococcal exotoxin, while 2 of the 12 were positive for 2 toxins. There were no positive results in the CRS without nasal polyps or control groups. There was a clear trend of increased TCRBV expression in the ELISA-positive group both for tissue and blood specimens. Staphylococcal superantigens were present in the nasal cavity of patients with CRSwNP with a high percentage of TCRBV, which suggests the possibility of superantigens as etiological agents of CRSwNP.

Accuracy of Acoustic Rhinometry Versus Computed Tomography in the Evaluation of Nasal Cavity in Patients with Nasal Polyposis

BACKGROUND Acoustic rhinometry (AR) accuracy in the diagnosis and follow-up of nasal polyps is as yet unclear. Our objective was to study its accuracy compared with computed tomography (CT) in patients with nasal polyps. METHODS We studied 29 patients diagnosed of nasal polyposis by nasal endoscopy. In all patients sinunasal CT-scan, AR and nasal nitric oxide (NO) were assessed. Nasal volumes between 0 and 5 (V(0-5)) and 5 and 9 (V(5-9)) centimetres from nasal inlet were measured with AR and CT-scan, by using Pearson and intraclass correlation coefficient tests. RESULTS All patients (29,79% males, mean age 48.2 yr [range 34-61]) had nasal polyps (score 2-3 on Lildholdt classification, score 0-3). Measurements (right plus left sides) were: AR 8.9 +/- 0.8 cm(3) (V(0-5)) and 15.5 +/- 3.6 cm(3)(V(5-9)); CT 6.5 +/- 0.4 cm(3) (V(0-5)) and 6.3 +/- 0.8 cm(3) (V(5-9)). Pearson correlation was r = 0.67 (p < 0.01) for V(0-5) and r = 0.62 (p < 0.05) for V(5-9). Intraclass correlation coefficient test was 0.51 (V(0-5)) and 0.28 (V(5-9)) for consistency; and 0.43 (V(0-5)) and 0.23 (V(5-9)) for absolute agreement. Low levels of NO (312.3 +/- 43.8 ppb) were found and the correlation between NO levels and volumes (V(0-5) or V(0-9)) measured by AR was not statistically significant. CONCLUSIONS Compared to CT-scan, AR measurements accurately reflect the geometry of nasal cavity volumes in patients with nasal polyps, with a better assessment in the anterior part of the nasal cavity.

Expiratory nasal sound analysis as a new method for evaluation of nasal obstruction in patients with nasal septal deviation: comparison of expiratory nasal sounds from both deviated and normal nasal cavity

The reliability of nasal obstruction measurements could be improved, and several new techniques are being developed. Our objective was to investigate the use of a new software program, Odiosoft-Rhino, in the assessment of nasal obstruction via analysis of the sounds of nasal expiration. We compared the nasal symptom scores and Odiosoft-Rhino and acoustic rhinometry test results for 61 patients with known nasal septal deviation. We found a significant difference, and a correlation, between Odiosoft-Rhino results at 2000-4000 Hz and 4000-6000 Hz intervals, and the minimal cross-sectional area 2.2 cm from the nostril, in the right nasal cavity in patients with right-sided deviations. Similar results were observed for the left nasal cavity in patients with left-sided deviations. The Odiosoft-Rhino software test is noninvasive, requires minimal cooperation and experience, and provides results that can be saved as digital data. Additionally, data from the Odiosoft-Rhino test are strongly correlated with acoustic rhinometry results and visual analogue scores of nasal obstruction. It seems that sound intensity within the 2000-4000 Hz and 4000-6000 Hz intervals is more sensitive than other sound intensity intervals. Thus, we speculate that Odiosoft-Rhino testing could be used as a new diagnostic method in order to evaluate nasal airflow in clinical practice.

Intranasal Helicobacter pylori colonization does not correlate with the severity of chronic rhinosinusitis

To investigate the prevalence of Helicobacter pylori (HP) in the nasal cavity of patients with chronic rhinosinusitis (CRS) and to correlate it with the severity of CRS. Intranasal HP was investigated using rapid urease (CLO) testing and immunohistochemical (IHC) analysis and confirmed with transmission electron microscopy. To evaluate the severity of sinusitis, CT scans were graded according to the Lund-MacKay scoring system, and CRS symptom scores were recorded. Twelve of 48 patients (25.0%) were positive, but only 1 of 29 (3.4%) controls was positive for both CLO testing and IHC analysis (P = 0.025). The mean preoperative CT grade (P = 0.439) and symptom scores (P = 0.515) were not related to the severity of CRS. Intranasal HP was more prevalent in patients with CRS than healthy controls. However, there was no significant correlation observed between the severity of sinusitis and intranasal HP colonization. HP has a limited role in pathogenesis of CRS.

Posterior Epistaxis: Identification of Common Bleeding Sites

The objective of this study was to determine common bleeding sites in the nasal cavity of patients with posterior epistaxis and thus review our management protocol. A prospective study was carried out from 1989 to November 2003 in the otolaryngology-head and neck surgery department of a tertiary referral center. This study included patients who presented with posterior epistaxis uncontrolled with standard nasal packing and with no identifiable bleeding point on examination under local anesthesia. All patients underwent a formal examination under general anesthesia by the senior author of this article. Findings at examination were documented along with subsequent management and its outcome. Forty-three patients were included in this study. Bleeding points were identified in 36 cases. Seven patients had septal bleeding points (20%). The rest were located on the lateral nasal wall (81%). Of these, 4 were on the lateral wall of inferior meatus, 7 on the lateral surface of inferior turbinate, 8 on the lateral wall of middle meatus, and 10 on the lateral surface of middle turbinate. All were located posteriorly. We recommend examination under general anesthesia when conservative measures fail to control bleeding, concentrating on the posterior aspect of the lateral nasal wall. In addition, the lateral aspect of the middle and inferior turbinates may contain a groove within which bleeding points may be concealed. The lateral position of most bleeding sites indicates that use of nasal packing can only attempt to indirectly tamponade blood flow and is rarely justified bilaterally. Electrothermocautery can achieve excellent results with minimal complications. Failure to identify a bleeding point, after thorough examination under general anesthesia, does not require further intervention unless complicated by further bleeding.

Isolated Soft Tissue Cleft Lip: The Influence on the Nasal Cavity and Supernumerary Laterals

The purpose of this investigation was to estimate the vertical deviation of the nasal floor and to register dental disturbances (i.e., hypo- and hyperdontia) in patients with an isolated soft tissue cleft lip. Thirty patients with isolated cleft lips were randomly selected from the files of the Department of Maxillo-Facial Surgery and Jaw Orthopedics. As a matched control group, 30 patients were selected from the files of the Department of Orthodontics. Panoramic radiographs were analyzed and the lowest point of the floor of the left and right nasal cavity was measured to the nearest 0.5 mm. The presence of supernumerary (deciduous or permanent) or missing lateral incisors was recorded from the patient's journals. The vertical position of the nasal floor differed significantly between the cleft and the non-cleft side (p < 0.001). Supernumerary, deciduous, and permanent laterals were recorded in 73% of the subjects in the cleft lip group (22 patients). In the control group, no differences were found between the position of the nasal floor on the left and right side and no supernumerary laterals were recorded. Missing laterals were not noted in any of the individuals investigated. Isolated cleft lips were in most cases associated with: (1) lowering of the nasal floor on the cleft side and (2) supernumerary primary or permanent lateral incisors on the cleft side. Panoramic radiographs can be used to detect differences in the vertical position of the floor of the nasal cavity in patients with isolated cleft lips and to diagnose supernumerary laterals.

Isolated Soft Tissue Cleft Lip: The Influence on the Nasal Cavity and Supernumerary Laterals

Objective: The purpose of this investigation was to estimate the vertical deviation of the nasal floor and to register dental disturbances (i.e., hypo- and hyperdontia) in patients with an isolated soft tissue cleft lip. Design: Thirty patients with isolated cleft lips were randomly selected from the files of the Department of Maxillo-Facial Surgery and Jaw Orthopedics. As a matched control group, 30 patients were selected from the files of the Department of Orthodontics. Panoramic radiographs were analyzed and the lowest point of the floor of the left and right nasal cavity was measured to the nearest 0.5 mm. The presence of supernumerary (deciduous or permanent) or missing lateral incisors was recorded from the patient's journals. Results:The vertical position of the nasal floor differed significantly between the cleft and the noncleft side (p < 0.001). Supernumerary, deciduous, and permanent laterals were recorded in 73% of the subjects in the cleft lip group (22 patients). In the control group, no differences were found between the position of the nasal floor on the left and right side and no supernumerary laterals were recorded. Missing laterals were not noted in any of the individuals investigated. Conclusions: Isolated cleft lips were in most cases associated with: (1) lowering of the nasal floor on the cleft side and (2) supernumerary primary or permanent lateral incisors on the cleft side. Panoramic radiographs can be used to detect differences in the vertical position of the floor of the nasal cavity in patients with isolated cleft lips and to diagnose supernumerary laterals. (Less)

The use of fibrin glue in refractory coagulopathic epistaxis.

Epistaxis can be particularly difficult to treat when a patient has a coagulopathy, even if the area bleeding is visible. Where routine measures fail to arrest the bleeding (e.g., nasal cautery and packing), the application of fibrin glue is successful in stopping the bleeding without having to address the underlying coagulopathy. Ten patients with epistaxis secondary to an underlying coagulopathy were treated by local application of fibrin glue to the area bleeding. The bleeding stopped immediately in all patients when the fibrin glue was applied. No patients suffered complications. Fibrin glue application should be considered as a cost-effective means of controlling epistaxis from an identifiable area in the nasal cavity in patients with a coagulopathy.

CT features of congenital nasal piriform aperture stenosis: initial experience.

To describe the computed tomographic (CT) measurements and features that enable accurate diagnosis of congenital nasal piriform aperture stenosis (CNPAS). The clinical and imaging features of six patients (age range, 0-11 months) with CNPAS were retrospectively evaluated and compared with those of 61 control subjects younger than 24 months. The average widths of the piriform aperture in patients aged 0-3, 4-6, and 10-12 months were 4.8, 7.0, and 6.0 mm, respectively, compared with 13.4 (P < .001), 14.9, and 15.6 mm, respectively, in the age-matched control subjects. The average areas of the piriform aperture in patients in the three age groups measured 0.24, 0.46, and 0.36 cm2, respectively, compared with 0.67 (P < .001), 0.86, and 1.11 cm2, respectively, in the age-matched control subjects. The width of the nasal cavity in patients with CNPAS was in the less than 5th percentile compard with that in the control subjects. Abnormal dentition and a midline bone ridge projecting from the inferior palate were present in all six patients. CT measurement of the piriform aperture width is a simple and accurate method for diagnosing CNPAS; a width less than 11 mm in a term infant is considered to be diagnostic. An abnormal dentition and a bone ridge along the underside of the palate are confirmatory imaging findings.

鼻アレルギー患者の鼻粘膜血行動態 自律神経作動薬の影響

Adrenaline, ipratropium or fenoterol was applied to one nasal cavity of patients with nasal allergy. The nasal mucosal blood volume (IHb) of both sides was measured with a tissue spectrum analyzer (TS-200, Sumitomo Electric Co. Ltd.) before and 5 min. after the application of the drugs.I) Unilateral application of adrenaline (0.01mg/ml, 0.12ml) decreased the IHb on the ipsilateral side but caused no change of the IHb on the contralateral side.II) Unilateral application of 20μg of ipratropium induced no change of IHb on either side.III) Unilateral application of 0.2mg or 0.4mg of fenoterol induced no change of IHb on either side.IV) Fenoterol (0.2mg) caused no significant difference in the IHb of patients with or without symptoms.V) In the patients treated with fenoterol (0.2mg), there was no significant difference of IHb between those who always used topical steroid and those who did not.These results suggest that the nasal mucosal capacitance vessels of patients with nasal allergy respond more to a-adrenergic stimulants than to β-adrenergic stimulants or anticholinergic agents.

Role of mucus and cilia on dysfunction in nasal mucociliary transportation in chronic sinusitis

Decelerated nasal mucociliary clearance has been demonstrated in patients with chronic sinusitis. However, it is as yet known whether this depression in mucociliary clearance is related to changes in the rheological properties of mucus, in the number and function of the cilia, or other factors. The purpose of this study was to determine if abnormal rheological properties of mucus or decrease of number of cilia contribute to the mucociliary dysfunction in chronic sinusitis.Nasal mucus was collected from 38 patients with chronic sinusitis and then, nasal mucociliary clearance (ST) was determined by saccharin granule technique. ST of the 16 patients was within normal range and ST of the other 22 patients was decelerated. Mucociliary transport rate of the nasal mucus on mucus depleted bullfrog palate was 5.93±1.04 mm/min in the patients whose ST was normal, and was 5.54±1.94 mm/min in the patients whose ST was decelerated. Significant difference in the mucociliary transport rate on frog palate was not observed between these two groups. This result suggests that rheological properties may not contribute to the slowing of nasal mucociliary clearance.The quantitative scanning electron microscopic study was performed on both nasal turbinate and maxillary sinus mucosae of 14 coupled samples. The epithelial surface occupied by cilia was determined using an image analyzer. The ciliated area of the epithelium was 90.2±9.9% in the nasal turbinate and 54.4±35.1% in the maxillary sinus mucosa from the patients undergone radical surgery. Cilia were not injured in the nasal cavity and were injured in the maxillary sinus in various degrees. This result shows that the slowing of nasal mucociliary clearance is not due to the decrease of the number of cilia.There was no decrease in the number of cilia in the nasal cavity in patients with chronic sinusitis. Rheological properties of nasal mucus are not the cause of the impairment of nasal mucociliary clearance in this disease. In conclusion, other factors such as tethering between outer mucous layer and mucus secreting cells and/or decrease of the thickness of periciliary fluid layer may play a major role for the deceleration of nasal mucociliary clearance associated with chronic sinusitis.

AN ACRYLIC OBTURATOR EMPLOYED IN THE REPAIR OF AN OBSTRUCTED FRONTONASAL DUCT

OTOLARYNGOLOGISTS have encountered fewer difficulties in preparing than in maintaining an artificially created passage from the frontal sinus to the nasal cavity in patients with an occluded infundibulum. Extranasal operations devised to create a frontonasal duct for adequate dependent drainage of the frontal sinus have become standard and reliable technics. But surgical procedures intended to prevent or to overcome the tendency toward partial or complete cicatricial stenosis of this newly constructed channel have been decidedly unsuccessful in a great many cases. Before making a plastic closure of an external fistula of the frontal sinus, it is essential that the frontonasal duct be open sufficiently to maintain drainage. If the sinus does not drain freely into the nose by a permanent channel, the fistula may recur. It was in making a frontonasal duct to secure drainage of the sinus that the present method was worked out. In a search for something