Suppuration or Abscess of the Antrum is indicated by a discharge of pus into the nose, sometimes producing scarcely any discomfort; at other times the severest local and constitutional suffering: an aching pain in the cheek, which is hot, flushed, and somewhat swollen; also in forehead and, as the symptoms increase, greater pain, of a throbbing character, with the rigors and fever peculiar to suppuration; an expansion of the bone of the upper jaw; an elevation of the malar bone, with a very apparent depression beneath it; the molar teeth on the affected side depressed so as to appear elongated, and to prevent the proper closure of the mouth ; an increase of pus; the palate losing its concavity and becoming convex; the nostril of the affected side being encroached upon, and, in protracted cases, the floor of the orbit of the eye so pushed up as to force the eye partly from its socket; the sight affected by the stretching of the optic nerve; the walls of the antrum becoming so thin as to afford evidence of fluid-fluctuation on pressure, and crepitus; at length the pus escaping through the cheek, or into the nose, or burrowing along the side of a root of a tooth and discharging into the mouth; the floor of the orbit giving way and the pus discharging along the lower eyelid.

Treatment

Make an opening into the antrum, either through the alveolar cavity of one of the roots of a superior first or second molar, or through the process between the roots of the first and second molars, which is the most dependent portion of the antral cavity, with a suitable trephine, and thoroughly wash out the cavity with a warm injection of saltTreatment 321 to water Oss, and if there is an offensive odor, syringe with a solution of permanganate of potash; then dress daily with a solution composed of carbolic acid one part, and oil of sweet almonds fifteen parts, applied on cotton secured in the cavity. If no improvement, then syringe the antrum with a solution consisting of carbolic acid tinct. iodine, iodide of potassium gr. xv, water viij.

Where a more powerful stimulant is required, use an injection of zinc, gr. x to the ounce of water. For systemic treatment, administer sulphide of calcium in the form of one-tenth of a grain pill three times a day after meals, doubling the dose if necessary. (Dr. Frank Abbott.) When an opening has been made into the antrum, sufficiently large to admit the little finger, the following treatment has proved effectual; syringe first with a warm solution of chloride of sodium, after which inject diluted peroxide of hydrogen, increasing the strength of the solution gradually if necessary, until the pus has ceased discharging; after this a solution of boric acid or listerine may be used. The injection of peroxide of hydrogen into the antrum through a small opening is not justifiable owing to its effervescent action on the pus. Dr. F. D. Weisse recommends injecting the antrum at least five times a day with a solution of hyposulphite of soda, one drachm to one ounce of water. Dr. J. S. Marshall recommends as a wash for the antrum, boracic acid twelve parts, salicylic acid four parts, water one-thousand parts; iodoform, iodol, aristol, pyoktanin, sulphonal and boric acid, in form of powder, are also recommended. M. Emile Denis recommends syringing out the cavity twice a day with a sixteen per cent. solution of boricine (see boricine), and then applying about a teaspoonful of the powdered boricine.