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made by Schwartze, a diagram indicates a less superficial position of the facial canal in the plane of the front wall of the external auditory canal than near the back wall. This is obviously true, since this nearly horizontal part of the canal parallels the oblique tubo-tympanic axis. The hiatus Fallopii (which nearly represents the position of the geniculate ganglion) I have found on the sectioned skull to be 4 to 8 mm nearer the middle line than is the stylo-mastoid foramen; but a number of measurements have shown no slightest greater distance outward of the exit-point than of the facial prominence above the oval window, and confirm my aforementioned findings. The real source of most of this error which I combat is a misapprehension as to the obliquity of the annulus. Its lower margin is some 6 mm deeper (mesial) than its upper, and the relation to the facial, which Schwartze cites as exceptional and constituting his "Flachverlauf," is the rule invariable in dozens of specimens which I have studied as to this point. The lower tympanic margin always lies some 3 mm internal to the corresponding level of the facial, as shown in Fig. 1.

Further, as to the distance of the facial canal posterior to the back wall of the meatus, stated by Schwartze to vary from "directly upon" to 1 cm away, a large number of measurements have found it never less than 2 mm nor more than 4 mm from this wall.

I can only reiterate as my conclusion that the descending course of the facial nerve to its stylo-mastoid exit is in all the cases studied almost exactly vertical and crosses the oblique plane of the drumhead some 3 mm back of the middle of the posterior margin of the annulus. Therefore in removing the back wall of the meatus we should aim to cut a little below the tympano-mastoid suture if we would keep in safe territory.

REPORT OF THE TRANSACTIONS OF THE NEW

YORK OTOLOGICAL SOCIETY.

BY DR. ARNOLD KNAPP, SECRETARY.

MEETING OF JANUARY 25, 1903. THE PRESIDENT, DR. J. B. EMERSON, IN THE CHAIR.

By invitation, Dr. A. E. SCHMITT presented bone specimens and drawings illustrating the topography and surgical anatomy of the temporal bone. The mastoid cortex was divided into four quadratic fields; the antero-superior corresponds to the antrum, the postero-superior to the sigmoid sinus, and the two inferior to the mastoid cells. The relation of the tympanum and antrum to the neighboring structures was shown, also an osteoplastic method of exploring the cerebellum.

Discussion.-Dr. DENCH thought that the incision shown in the drawings was too small; he had found that it was necessary in doing the radical operation to start the incision well anterior to the auricle, and that it was better to have the descending portion of the incision 1 to 2 cm behind the insertion of the auricle; he thought that the osteoplastic flap was an excellent procedure for exploration.

Dr. GRUENING questioned the practicability of retaining these squares in operations.

Dr. ARNOLD KNAPP thought that the plates were misleading as a guide to operations because the membranous canal had been

cut out.

Dr. DENCH thought that the diagram describing an exploratory antrotomy was excellent, and that there was an indication for this operation, although he had recently seen two cases where he had exposed the antrum and found it more or less free from disease; but the cells below the antrum were filled with pus. The suggestion of packing off the antrum before extending the

operation in a posterior direction, as for exposing the sinus, was

not a new one.

Dr. DUEL thought the specimens were instructive from an anatomical standpoint, but hardly in accord with modern operative procedures.

Dr. WILSON gave a further report on a case of epithelioma of the auditory canal. This patient, twenty-eight years of age, was first seen in March, 1900. A nodule was removed from the posterior wall of the right canal. It recurred in January, 1901, was removed a second time, and in April, 1902, recurred again. Microscopic diagnosis by three pathologists was epithelioma. Since April, 1902, the patient has been treated with the X-ray; between fifty and sixty applications have been made, the average being two a week. It had been his privilege to examine the case after each application, and he had never seen the slightest reaction on the part of the tympanum. Under this treatment the growth had shrivelled up and disappeared two months ago. There were absolutely no unpleasant effects, and up to the present time there had been no signs of recurrence. Hearing normal.

Discussion.-Dr. HARRIS spoke of a case of lupus vulgaris of the external canal, which he had under observation for one year. This was treated by the X-ray for six months. Slight irritation was caused; the ulceration, however, healed and the process apparently stopped, but the healing never lasted for more than one month.

Dr. HEPBURN said that epithelioma elsewhere was being treated with benefit by the X-ray; he had seen some cases recur of epithelioma about the eyelids, which were benefited by this treatment, and without any reaction.

Dr. DENCH reported a case of sarcoma of the tympanum and mastoid in a child aged eighteen months. When first seen there were some granulations in the canal, and paralysis of the sixth nerve. The tissue removed was diagnosed as granulation tissue with an epithelial covering. The mastoid was opened; a cartilaginous, cauliflower-like mass presented, breaking through the temporal bone and invading the dura. This was cleaned out. Microscopic examination revealed an endothelial sarcoma. currence in the depth was expected. The case disappeared from view, and when seen five weeks later the wound had healed and recurrence apparently had not taken place. The patient meanwhile had been treated with the X-ray. Five weeks later the

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whole side of the head was very much swollen. He tied the common carotid artery in order to arrest the progress of the growth. This had very little benefit. The tumor is now rapidly growing and is invading the pharynx.

Dr. DENCH also spoke of facial paralysis occurring after the radical operation; he had observed some cases where the facial nerve became paralyzed on from the fourth to the tenth day after operation. The paralysis was slight and transient; he thought it was probably due to a neuritis of the nerve. In one case the paralysis was immediate, in which he thought that the chorda tympani had been injured and the traumatism had thus been transmitted to the facial nerve.

Discussion. - Dr. GRUENING had seen four cases of facial paralysis, all occurring after the second dressing, and due to pressure exerted by packing which had been done by an assistant.

Dr. BACON had had a similar experience, and thought the paralysis was due to the packing.

Dr. BERENS inquired if this paralysis was due to the packing, why it did not come on immediately; he thought that most cases of paralysis were due to traumatism or leakage; he also thought that the part of the Fallopian canal over the promontory was the most vulnerable.

Dr. FRIEDENBERG thought the facial paralysis was frequently due to concussion.

Dr. DUEL was of the opinion that the paralysis was brought on by a neuritis, subsequent to either traumatism or infection; he thought that the heat generated by the burr might be responsible, in many cases.

Dr. GRUENING said that the course of the facial nerve is variable; hence, the operator is not to be blamed for paralysis in every case.

Dr. BERENS reminded the Society of the specimen which he had presented a year ago of the anomalous course of the facial nerve, where the nerve was bound to be injured in doing even a simple mastoid.

Dr. KNAPP asked how the sixth nerve paralysis was to be explained in Dr. Dench's first case.

Dr. DENCH thought it was due to inflammation of the dura in the middle cranial fossa.

Dr. FRIEDENBERG had operated on a case and had found

after passing through the mastoid cortex a white, cauliflower-like tumor growing through the bone.

Dr. DENCH thought that if the pressure of the packing caused paralysis, it should be instantaneous and should be relieved by removal of the packing.

Dr. GRUENING had recently had a case of suppurative middleear trouble under treatment, which was unusually obstinate; the drum bulged and a teat-like protrusion presented with a central opening. He thought these protrusions were unusually difficult to treat. The suggestion of removing this with the cold snare he had found impracticable and he had been able to remove the entire protrusion with the alligator forceps; this was followed by a rapid cure.

Discussion.-Dr. BERENS in some cases had had very good results from the use of the ring knife.

Dr. DENCH thought this was due to proliferation of the mucous lining of the tympanum; he had operated on a case where there was a mass of granulations in the depths of the canal, which he could not remove, but which after the application of strong silver nitrate solution shrivelled to such an extent that he was able to see it protrude through an opening in the membrana tympani. This mass grew smaller and apparently became snared off by nature. He thought it was an hypertrophy of the posterior fold.

Dr. GRUENING thought these cases were not due to proliferation of the mucous lining, and quoted Katz's investigations which showed that the skin layer only about the perforation was involved.

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