Incorrect Treatment of Osteomyelitis of the Frontal Bone

Abstract

The period before 1941 might be appropriately designated as 1941 B. C. (before chemotherapy), whereas, the period after 1941 could be christened A. D. (after diazine). I am convinced that chemotherapy will surely modify, even revolutionize, the treatment of osteomyelitis." 1 This and similar statements appearing in recent articles on osteomyelitis of the frontal bone furnish the real incentive for writing this paper. I was lulled into a feeling of false security and neglected to follow out the surgical procedures that I had advocated in previous writings.2The following report of a case may be the means of warning others that chemotherapy is not always successful. REPORT OF A CASEA woman aged 35, the mother of two children, suffered from chronic pansinusitis with questionable allergy. I had examined her on various occasions during the past fifteen years. Twelve years ago I had performed a Caldwell-Luc operation on her left antrum, an intranasal ethmoidectomy and an intranasal operation on the right antrum. This gave only tem¬ porary relief. Two years later she had surgical treatment for an acute involvement of the left mastoid. Healing was without incident. After this she was operated on elsewhere for "sinus trouble" without obtaining permanent relief.In the meantime she had married and lived in Chicago. During the past three years chronic bronchitis had developed and she had a profuse foul discharge from both nostrils, a productive cough and daily frontal headache. She was under the care of an excellent and conservative rhinologist, who advised that she should have an external operation on both sides for the chronic disease of the ethmoid, sphenoid and frontal sinuses.Because her parents lived in Boise, Idaho, and her two children could be cared for more easily there than in Chicago and because she had survived my earlier operations without mis¬ hap, she returned to Boise, with the approval of my Chicago confrere.The internist reported her general condition to be good except for some moist rales and a peribronchial thickening which he thought was due to her chronic sinus infection. The radiologist reported dense clouding of all paranasal sinuses with loss of aeration. The sphenoid sinuses were small and densely clouded.I felt appprehensive about my patient, and I decided to hospitalize her and to give her a course of sulfathiazole (2-[paraaminobenzenesulfonamido]-thiazole) before operation. The white blood cell count was 10,500. Beginning on Feb. 8, 1942, 15 grains (0.97 Gm.) of sulfathiazole was given every three hours. Three days later the level of sulfathiazole in the blood was 18 mg. per hundred cubic centimeters ; the white blood cell count was 10,800. A careful check was made on her intake and output of fluids, and the urine was examined carefully for crystals.With the region under local anesthesia induced with morphine and pentobarbital sodium, the right side was operated on. An external curvilinear incision was made, and the remaining anterior and posterior ethmoid cells were exenterated thoroughly. The f...