[Reprinted from THE MEDICAL NEWS, March 9, 1895.] 
CARCINOMA OF THE RIGHT MAXILLARY 
ANTRUM.' 
RV ARTHUR If. CLEVELAND, M.D., 
CLINICAL PRnPRSSOR OP LARYNGOLOGY, MltlTico-CHIRURGICAL COLLRGR ; 
5UBGBON TO THROAT, NOSR, AND KAR DISPBNSARY, 
PRESBYTERIAN HOSPITAL, PHILADELPHIA, PA. 
R. T., a colored woman, whose age was not exactly 
known, but who was probably in the neighborhood of 
sixty years old, was first seen at the clinic of the Presby- 
terian Hospital on March 13, 1893. She gave a history 
of nasal trouble of over three months' duration, during 
which time she had been under constant treatment else- 
where, and had been several times cauterized. There 
was stoppage of the right side of the nose, with consider- 
able discharge, both muco-purulent and crusty. Coin- 
cidently with the nasal trouble, she said, she began to 
have pain in the right ear, with dulness in hearing. The 
pain extended to the back of the neck, and there was 
stiffness of the jaw, with pain on opening the mouth 
widely. The patient claimed to have had no nasal 
trouble previously to this attack. The family history 
was hard to obtain and unsatisfactory. 
Examination showed the right nostril filled with muco- 
pus. The lower turbinate was somewhat enlarged, bu 
the middle turbinate was much enlarged and inflamed. 
A posterior view was not obtainable. The pharynx was 
not much congested. The right membrana tympani 
1 Read (by invitation) before the Section of the 
College of Physicians, December n, 1804. 2 
was considerably thickened; the left thickened and 
opaque, and in the posterior lower segment, below the 
malleus handle, were some chalk concretions. 
As the last “burning” had been but recently done 
I attributed the inflammation to that, and prescribed a 
weak alkaline wash, to be used twice daily. 
On March 29, 1893, the patient returned, still com- 
plaining of the discharge and stoppage. The inflamma- 
tion seemed to have decreased, and attached to the right 
middle turbinate posteriorly was what appeared to be a 
large raspberry polyp. Its removal by the cold snare 
was followed by copious epistaxis, not, however, suffi- 
cient to be alarming. The nostril was plugged with 
gauze for a short time, but this was soon removed. 
The sensation afforded by the snare while cutting 
through the growth was peculiar and hard to describe, 
but very characteristic. It was as if the tissue was em- 
physematous and the fibers brittle. 
The polyp showed nothing peculiar except that there 
were some evidences of inflammation and small con- 
nective-tissue trabeculae running through it. 
Microscopic examination was not made. 
On April 3, 1893, the woman again returned with the 
discharge persistent. Examination showed the middle 
turbinate still swollen and very much inflamed. There 
had been one or two attacks of epistaxis, not of long 
duration, but very free while they lasted. The aural 
pain still persisted. She was again given a nasal wash, 
hoping that a few days would reduce the inflammation 
and allow more extended examination. 
The patient did not return after this, and on the first 
of May the dispensary nurse looked her up, finding her 
at home and in bad condition. 
She was immediately brought to the hospital and ad- 
mitted to Dr. H. R. Wharton’s ward. Through his kind- 
ness I was enabled to see her there. The first visit 
confirmed to my mind the diagnosis of carcinoma, which 3 
I had before guardedly made. There was swelling of the 
entire right side of the face; the right eye was promi- 
nent, and the lids edematous, with considerable conjuncti- 
vitis and discharge, owing to inability to close them. 
The pain in the ear was still severe and persistent. The 
temperature varied slightly from 990. Operation was 
thought inadvisable, and the patient gradually sank and 
died from exhaustion on May 12th. 
The autopsy was made by I)r. H. W. Cattell, and from 
his notes, supplemented by later examination of the 
specimens, which I was privileged by the family to re- 
move, we obtain the following : 
A large extra-dural mass involved the neighborhood 
of the sphenoid bone superiorly, extending anteriorly to 
the crista galli and the orbital plate of the frontal bone 
on the right side. Posteriorly it extended nearly to the 
anterior margin of the petrous bone. The sella turcica 
seemed broken down and incorporated in the mass, which 
was of a soft consistence, and was infiltrated with pock- 
ets of sanious pus. The right optic foramen was much 
enlarged and the bones disorganized. The eye on that 
side was diseased, shrunken, and discharging pus. The 
optic nerve in its backward course penetrated the mass 
of new growth and soon became unrecognizable. The 
cavity of the tympanum was not affected, the bones and 
membrane being intact. Helow, the right maxillary 
antrum was filled with a gelatinous mass mixed with 
pus. The bony walls were apparently sound except 
posteriorly, where they were eroded. The lower turbi- 
nate was not enlarged anteriorly, but posteriorly had 
reached a large size. I he middle turbinate was much 
involved, being enlarged in its whole extent. The sep- 
tum was not affected. The growth and position of the 
mass pointed to an origin in the antrum. Microscopic 
examination of a specimen from there showed it to be 
a carcinoma. 
108 S. SuVRNTKKNTH SthRRT.