Sinus (anatomy)

“ The coronary sinus receives blood from coronary veins, which collect it from the walls of the heart.
In the auricular septum ventrad of the opening of the inferior vena cava is seen a faintly marked smooth oval depression, the fossa ovalis. When the auricular septum is examined by transmitted light it is seen to be thinner over the fossa ovalis. There is an opening, foramen ovale, at this point in fœtal life, so that the blood of the inferior vena cava then passes directly from the right auricle to the left auricle. ”

“ No brain abscess. Ventricles contained more than normal quantity of fluid. Frontal sinuses and cribriform plate of ethmoid and ethmoidal cells normal.
To right of the sella turcica there was some necrosis of the walls of the sphenoidal sinus. Probe readily passed from base of skull through sphenoidal sinus into the nose. Large free opening from said sinus into nose, which sinus was full of muco-pus. Cavernous sinus not thrombosed. Right antrum of Highmore contained about a dram of thick glairy mucus. ”

“ To expose this tributary, which enters the lateral sinus at the point at which it turns downwards to form the sigmoid sinus, bone must be removed in front of the lateral sinus along the angle forming the roof and inner wall of the mastoid and antrum; that is, along the superior margin of the petrosal bone. If the inner surface of the lateral sinus in its neighbourhood be normal, nothing need be done. If, however, the sinus wall be infected, the petrosal sinus should be followed out, if possible, its outer wall being incised and the clot removed, bleeding being afterwards arrested by pressure. ”

“ The sphenoidal sinus is involved in at least 40-50 per cent. of basic fractures, comminution of the sinus wall being often so excessive that a probe can be passed with the greatest ease from the middle fossa into the naso-pharynx. Blood is thus allowed to escape readily into the naso-pharynx, and a source is opened up for the possible development of meningeal infection. ”

“ However, the honor of having initiated the rational treatment of diseases of the maxillary sinus is not exclusively due to William Cowper and to James Drake; a large share is also due to the celebrated German250 physician and anatomist, Heinrich Meibom. The mucous membrane of the maxillary sinus was considered by him as the real point of departure of the diseases which occur in this cavity, it being liable to become inflamed and to suppurate, thus giving rise to much pain and to various accidents. ”

“ The presence of a foreign body is often suggested by a mass of redundant granulations at the mouth of the sinus. If a sinus passes through a muscle, the repeated contractions tend to prevent healing until the muscle is kept at rest by a splint, or put out of action by division of its fibres. The sinuses associated with empyema are prevented from healing by the rigidity of the chest wall, and will only close after an operation which admits of the cavity being obliterated. ”

“ The discharge from them is304 profuse and fetid, and in some cases blood flows in no small quantity. Such growths usually commence in one or other of the sinuses connected with the cavity of the nose—sometimes, though rarely, in the frontal sinus. When seated in the antrum maxillare, pain is experienced in the cheek for a short time before swelling occurs. Soon the part enlarges, its coverings are thickened, the bony cavity expands, and the patient’s sufferings are excruciating. The teeth loosen, and sanious matter is discharged from their roots. ”

“ Sometimes, indeed, there are no clinical symptoms, the condition perhaps only being discovered whilst performing the complete mastoid operation as a prophylactic measure. The sinus is generally exposed accidentally whilst following out a tract of carious bone, and, to the surprise of the surgeon, pus or granulations may be seen to exude or protrude from an opening in its outer wall. On further exposure of the sinus on each side of the thrombus, the dura mater may appear to be of a dark colour for a short distance, but beyond this to be of normal appearance. ”

“ Sinus.#--A sinus is a track leading from a focus of suppuration to a cutaneous or mucous surface. It usually represents the path by which the discharge escapes from an abscess cavity that has been prevented from closing completely, either from mechanical causes or from the persistent formation of discharge which must find an exit. A sinus is lined by granulation tissue, and when it is of long standing the opening may be dragged below the level of the surrounding skin by contraction of the scar tissue around it. ”

“ The sinus leaving the dorsal end of the heart is called the cardio-visceral vessel, and this, after giving off to the test the branch above mentioned, breaks up into a number of sinuses, which ramify over the alimentary canal and the other viscera. These visceral lacunae finally communicate with a third great sinus, the viscero-branchial vessel, which runs forward along the dorsal edge of the branchial sac externally to the dorsal lamina and joins the dorsal ends of all the transverse vessels of the branchial sac. ”

“ L. H. Runge, a surgeon of Bremen, published, in 1750, a monograph on the diseases of the frontal and maxillary sinuses. He says that in cases of inflammation of Highmore’s antrum, the pus may make its way, corroding the bone, as far as the alveoli, or, sometimes, as far as the orbital cavity; and, vice versa, alveolar suppuration can give rise, by diffusion, to abscess of the maxillary sinus. In this latter, tumors of various kinds may form (polypi, cysts, sarcomas, cancers, exostosis) , the existence of which is ignored at first, and only becomes manifest tardily. ”

“ Feb. 19th, 9 a.m.,—pulse 106, temp. 99.5. Both sinuses discharging very freely. Made an opening in the lower part of the pouch to the left of the pubis for better drainage, as the patient usually lies [Pg 14] on the right side. Laxative has operated. After washing out both sinuses with a five per cent. solution of carbolic acid, I inject the smaller sinus with liquid vasaline.
Feb. 20th, 9 a.m.,—pulse 112, temp. 103.5. There is a great amount of pus being discharged from the large sinus on the back, not so much from the small one. Patient had a chill last night. ”

“ Removal of too much of the inferior turbinal is apt to induce a scabby condition.
But persistence of nasal suppuration after this operation is generally found to be due to overlooked disease in some other sinus. The ethmoid is so frequently affected that it should always be carefully explored, and treated either before or at the time of the operation upon the maxillary sinus. Any suspicious-looking cells can be cleared away under cocaine during convalescence. Suppuration in the frontal sinus will have generally been excluded beforehand. ”

“ The fourth species of sinuses, are those where a specific action exists39, and prevents the healthy ulcerative action from forming. Of this kind is the scrophulous sinus, which is generally accompanied with a caries bone, or diseased cartilage, and, therefore, is a complicated sinus40. This is distinguished, where the bone is diseased, by a shining or polished red skin, like a cicatrix, surrounding the fungus papilla at the orifice of the sinus, or the scrophulous-looking sore which exists there. When no caries bone exists, we have no papilla, but only the diseased ulcer at the orifice. ”

“ These fistulæ may open into the rectum, bladder, vagina, uterus, or some spot on the anterior abdominal wall below or near the umbilicus. The treatment is simple, and consists in dilating the sinus and extracting all the fragments. If this be thoroughly carried out the sinus quickly closes. Partial operations are useless: if but a bit of a bone remain, a troublesome sinus will persist. It is bad practice to attempt to extirpate the sac in such condition; such an operation usually terminates fatally. ”

“ He states that the blood is derived from one or more radicles of the superior longitudinal sinus, especially from those veins which, in their upward passage in the sulci of the brain, leave their cerebral beds for a short and comparatively unprotected course, immediately previous to their entry into the lacunæ laterales of the superior longitudinal sinus. ”

“ These blood sinuses pass usually from before backwards: a superior longitudinal along the upper border of the falx cerebri as far as the internal occipital protuberance; an inferior longitudinal along its lower border as far as the tentorium, where it joins the straight sinus, which passes back as far as the same protuberance. ”

“ In cases of unilateral multi-sinusitis, if a suitable tooth socket be available, the alveolar operation serves both to determine the condition of the maxillary sinus and to establish drainage, while the other cavities are being investigated or treated. In patients who are too old or feeble to endure more radical measures, or who decline them, the obturator may be left in indefinitely. ”

“ This species is distinguished by our feeling the extraneous body, or diseased bone, with the probe, and by the fungous protuberance, or papilla, which shoots out from the orifice. In addition to the method of curing other sinuses, we must here endeavour to remove the adventitious cause, which is generally very difficult to be done. If the foreign body be deep, or if the diseased bone lie deep, and the sinus be narrow, we can do little in this way ”

“ This type of vascular system is pretty generally adhered to throughout the Order, but in the Terebelliformia, Scoleciformia, and Cryptocephala the dorsal vessel and capillary plexus on the intestine are replaced by a continuous blood sinus, situated in the substance of the gut-wall. This "perienteric sinus" has the same relation to the segmental vessels as the dorsal vessel has in the Nereidiformia, and from it a tubular dorsal vessel arises anteriorly. In Arenicola the sinus is preceded in the young stage by a network the branches of which gradually enlarge, meet, and fuse to form the sinus. ”

“ In the event of the wound being compound, air may enter into the sinus. Insomuch, however, as the sinus pressure is, under normal conditions, positive, this complication is of rare occurrence, unless the patient is in a state of profound shock, from loss of blood, or suffers from urgent dyspnœa. ”

“ If this sinus have remained long open, its surface, like that of the chronic abscess, becomes changed, and a coat is formed, like the cyst of a tumour. When this is thick and hard, the sinus has been called a fistula, and it has been deemed necessary to dissect out the tube; but it is in general sufficient to use the remedies which increase the vigour of the action, and make it run its natural progress; such as the seton, or a free incision, if the parts be superficial, or no considerable vessel or nerve runs the risk of being wounded. ”

“ The sinus also receives ducts from the hinder part of the mesonephros, either separately, as in the female, or by a common duct on each side—the so-called metanephric duct—as in the male. Two tubular caecal outgrowths from the sinus form two sperm sacs. Only the anterior portions of the Müllerian ducts with their coelomic apertures are retained in the adult. ”

“ If a sinus or sinuses have formed under the skin or between the muscles, from the extension of disease in the cellular or areolar structure, they must be laid open, and the cautery applied; for if any part affected be left untouched or undestroyed by the acid, the disease will recommence and spread from that point. ”

“ The most simple species of sinus may be called mechanical, and is produced by matter flowing from a neighbouring cavity, and which cannot be freely discharged: Thus, for instance, if a deep abscess open at the highest part, or at a point above the level of its bottom, the matter constantly oozes out, and keeps the canal open. ”

“ Its hemostatic power is also observed in bone cavities. Care should be taken never to use it unless there is a free [Pg 25] exit, as it increases rapidly in volume after coming in contact with dead tissue or pus, and serious accidents have happened from its improper use; for instance, if it is injected into an abdominal sinus where free escape is not provided for, the distention will result in ruptures of the sinus and infiltration of the surrounding tissues; possibly of the peritoneal cavity. ”

“ From an examination of many skulls in the Hunterian Museum, I find that the absence of the ‘bumps,’ even in middle age, does not necessarily imply the absence of the sinuses, since they may be formed by a retrocession of the inner wall of the skull. In old persons, as a rule, when the sinuses enlarge, it is by the encroachment of the inner table on the brain case. ”

“ We consider that stimuli are also propagated from one chamber of the heart to another through nervous channels: thus we find that irritation of the venus sinus will sometimes produce simultaneous contractions of the auricle and ventricle, instead of the ventricular beat succeeding the auricular in the ordinary way. ”

“ In proportion as the horn core grows, there develops within it a cavity which may either be of a simple character or divided by a longitudinal partition. This communicates with the frontal sinus, a fact which explains the collection of pus in the sinuses as a result of injuries to the horns. The sinus of the horn core does not exist in young animals, and is not completely developed before the third or fourth year of life. ”