About  a  year  after,  the  child  fell  upon  its  face,  and  caused  a  consider-
able discharge  of  matter  from  its  nose,  at  the  same  time  bruising  the
tumor.  No  other  injury  was  received,  and  the  tumor  did  not  increase
perceptibly  in  size  from  the  eighth  to  the  fifteenth  year.  During  the
next  year,  however,  it  sensibly  augmented,  and  from  the  sixteenth  to
the  eighteenth  year  it  attained  so  great  a  volume  that  the  floor  of  the
orbit  was  elevated,  which  caused  a  diminution  in  the  size  of  the  eye,
and  restricted  the  motions  of  the  eyelids.  The  arch  of  the  palate  was
depressed,  and  the  nasal  fossa  almost  closed.  The  nose  was  forced  to
the  right  side  of  the  upper  part  of  the  tumor,  and  there  was  a  consider-
able elevation  beneath  the  sub-orbital  fossa.  The  skin  below  the  infe-
rior eyelid  was  of  a  violet  red  color,  and  very  tense.  The  upper  lid
was  elevated,  and  the  gums  on  the  left  side  protruded  beyond  those  on
the  other  side  of  the  arch.  Respiration  was  painful,  and  the  patient
spoke  with  difficulty.  Sleep  was  laborious,  and  mastication  was  attended
with  pain.  "  In  this  state,"  says  M.  Boyer,  "  he  was  seen  by  M.  Dubois,
September  1st,  1802  ;  but  as  he  was  not  able  to  determine  on  the  proper
operation,  M.  Sabatier,  M.  Pelletan,  and  himself  were  called  in.  It
was  the  opinion  of  all  that  there  was  a  fungous  tumor  of  the  antrum,
and  for  the  removal  of  this,  M.  Dubois  was  requested  to  make  choice
of  his  own  method  of  operating."

A  fluctuation  was  felt  behind  the  upper  lip,  and  this  determined  M,


DISEASES    OF    THE     MAXILLARY    SINUS.  479

Dubois  to  coramoiice  the  opLTiitiou  by  making  uii  incis^ion  tlu'iv,  which
was  followed  by  the  discharge  of  a  large  quantity  of  glairy,  lymphatic
substance.  Through  this  opening  a  sound  was  introduced  into  the
antrum,  and,  to  M.  Dubois'  surprise,  this  cavity  contained  no  tumor;
but  upon  moving  the  sound  about,  it  struck  upon  a  hard  substance,  in
the  most  elevated  jiart  of  the  sinus,  which,  on  being  removed,  proved
to  be  a  canine  tooth.  Preparatory,  however,  to  its  extraction,  two
incisors  and  one  molar  were  removed  and  their  alveoli  cut  away.
