ABSCESS OF THE ANTRUM.
In one sense the antrum would be more appropriately considered under diseases of the mouth, but for various reasons it seems best to place it here. The anatomy of this cavity renders it little liable to extensive morbid action, but probably inflammation of the lining membrane, in connection with coryza or nasal catarrh, is much more common than we are aware of. According to OTTO there is very great variation in the size of this cavity; at times covering the whole of the dental arch, again only corresponding to two or three teeth. The same variation, I think, is observed in the outlet; in some cases being quite on a level with the floor, at others considerable above it; the latter by far the most common. These anatomical considerations will go far, perhaps to explain some of the phenomena to be considered.
When we speak of abscess of the antrum, we manifestly do not refer to a suppurating disease of the bony walls, but to a collection of pus, secreted, or derived from the mucous lining, and prevented from finding an exit through closure, by some means of the nasal duct. Usually the nose is primarily affected, and the inflammation extends to the antrum; at first the swelling is not sufficient to prevent the escape of the pus, but the mucous membrane soon becomes pouted about the outlet, and when small will effectually occlude it. There is very much variation in the size of the outlet, as well as with reference to the elevation. At times it is so small that as ordinary probe cannot be made to enter but with difficulty; at others it will admit the point of the little finger readily. When the outlet is small of course the occlusion from swelling occurs more readily; when large the stoppage is usually from rhinolithes, or inspissated pus or mucus.
The first symptom will be a feeling of tenseness and slight pain in the region of the antrum, rapidly increasing swelling, with corresponding increase of pain. Occasionally the pus will accumulate until the cavity is completely filled, when a drop may exude through the duct, and give temporary relief when the swelling is at its height, the pain becomes throbbing and pulsative, extending to the eye, sometimes materially interfering with vision. The malar bone is pushed down so that the teeth seem longer, and the disfigurement is very great. The symptoms are very unsatisfactory, both objective and subjective, and but little certainty can be felt in the diagnosis until the pus is detected in trying to make an escape, which it ultimately does in one of four directions. The touch gives a sensation of a thin expansion of the bone, crackling, under light pressure, like parchment or an egg-hell. The external inflammation, that of the integument-is not all times high, but is always noticeable.
The result of the process is either in necrosis of the bones, or spontaneous discharge of pus, the latter so frequently as to be considered the rule. In this event it will point in the cheek, when left to nature, be discharged through the socket of a canine tooth, through the nose, or, through the orbital plate; the latter is very rare.
The causes have already been partly given, and we can only add at this time two conditions which are likewise originated without the antrum. The most common is the irritation from a carious tooth.
There is an accumulation of the normal secretion, some times occurs, known as dropsy of the antrum, which may undergo degeneration and become pus. This is largely due to occlusion of the small duct by inflammatory action, or inspissation of mucus.
The treatment, by remedies alone, will always prove very unsatisfactory; indeed, from obvious reasons, it will be contra- indicated unless conjoined with instrumental measures. The imprisoned pus must be evacuated; and here let me say, while not included in our plan, that the time honored rule in suppurating affections must here be disregarded. The pointing will often be in the cheek; it is essential to avoid this, and so a drill must be employed, and the antrum opened in the mouth or nose. Remedies will have an important part to play, however, in the subsequent treatment, or even in the beginning if the actual condition can be determined; viz., to prevent the formation of pus, or failing this to regulate and shorten the process. For the first indication Mercurius will be the remedy; for the second, Hepar sulph. If extensive mischief is done the bones, consult caries, and necrosis.