One of the problems often faced by the roentgenologist is the visualization of draining sinus tracts. Treatment of these cases often presents an even greater problem to the surgeon, if he does not know the extent and communications of the tract. The method usually followed, to fill larger sinus tracts with contrast solution, is through the use of a rubber catheter inserted into it. For small tracts, in which a catheter cannot be inserted, a blunt needle or small cannula is sometimes used with success. The deficiencies of both these methods are soon apparent to anyone who tries them. The most important causes of failure are: (1) Many tracts are so crooked that a catheter cannot be inserted into them even though their size seems adequate. (2) The contrast solution often flows back toward the surface between the catheter and the sinus wall and escapes at the mouth of the sinus without outlining any of the tract beyond the tip of the catheter. (3) Attempts to introduce a cannula or blunt needle into a very small tract, the direction of which one does not know, causes trauma and pain and sometimes results in the deposit of the contrast solution in the subcutaneous tissues. (4) It is very difficult to keep the solution from draining out before the patient can be properly positioned and films exposed. The contrast solution which has leaked onto the skin surface obscures the tract and many timesis confusing in interpretation, especially in single films. (5) If the injection is made under fluoroscopic control, as it should be whenever possible, the catheter or cannula is easily displaced in rotating the patient for proper visualization in the different positions. (6) More time is usually consumed in preparing for the injection than in the procedure itself and this not only takes up the operator's time but ties up the fluoroscopic room. All of these factors, together with the mediocre results so often obtained, cause this valuable diagnostic procedure to be neglected. We therefore devised a very simple but effective apparatus for this purpose which has been found to overcome all the difficulties enumerated and makes the injection of a sinus tract almost as simple as administering a barium enema. The essential part of the apparatus was made by our mechanic, Mr. J. N. Hippie. The apparatus consists of a small shallow cup about one-half inch in diameter which fits over the mouth of the sinus tract. This is surrounded by a flange and a soft rubber disc, about an inch wide, which form a shallow vacuum chamber around the cup. The central cup and the surrounding chamber open to the outside through separate outlets so designed that rubber tubes can be connected to them. Accessories consist of an ordinary water vacuum pump, a length of vacuum tubing, a syringe for contrast solution, and a small tube fitted with adaptors for connecting the syringe to the cup.
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Oct 1, 1978
Glen Spielbauer 
