The Treatment of Oro-Maxillary Fistulæ caused by the Extraction of Teeth

Two hundred and ninety years ago Nathaniel Highmore described the earliest recorded case of oro-maxillary fistula in the following terms:-"A gentlewoman who had the dens caninus (Irawn on account of an inveterate (lefluction of sharp humor, on thrusting a silver bodkin into the alveolus was exceedingly frightened to find(it pass as it (lid almost to her eyes. Upon further trial with a small feather stripped of its plume, she was so terrified as to consult a doctor andl others imagining nothing less than that it had gone to her brain. But they, considering the circumstances, found that the feather had doubled only into the cavity." Keith (lescribes the (levelopmenit of the maxillary anltrum as followvs "At birth the sinlus is only a slialloxv recess oni the outer wall of the midldle mcatus above the germ of the first milk molar tooth. It continues to grow until the twenty-fifth year, and is the only onie of the air siniuses (levelope(I from the nasal cavity which is more than a rudiment at the time of birth. In the years of adolescence the sinlus expands until it inflates the maxillary part of the molar. As it expands backwards, the posterior border of the maxilla which contains the buds of the permanent molar teeth undergoes a rotation dlownwards, so that what was situatedl on the posterior border comes to be situatecl on the alveolar border. "If the process of growth and rotation are arrested, the last molar tooth is left on the posterior bor(ler of the maxilla, where it may give rise to pain and suppuration. " IThe thickness of the antral floor anid the number of teeth which are in relationshlip to it are conisequetntly somewhat variable. TIhe roots of the first or second molar or the second bicuspid most conmmonly may penetrate the floor, but where the antrum is large its floor may extenid from the caninie tooth to the third molar. The antrum may be opene(d during a (lental extraction, whlere for developmenlt rcasons the floor is so thini that the roots of the tooth project through it, or where there is such a (legree of infectioni roun(l a root that the sinus floor necroses and readily comes away when the tooth is extracted. Tlhouglh it is not uncommon for the antrum to be thus opened, an oro-maxillary fistula is not often seen. It would seem that it is a failure …