How Mr. Nose is laid out...
The maxillary sinuses -- the big sinuses -- are just beyond what you see in the cross-section that will load below. (FYI, since sinuses are in pairs, their mirror twin would be located in front of this cross-section.) These sinuses are the big reservoirs behind the cheekbones. The teeny tiny itty bitty lacrimal duct (#19) is supposed to drain things in and out. But in Wes' family it doesn't. Maybe it's our mucous. I really don't know.
But anyway, this buildup of stuff in the maxillary sinuses can lead to -- you guessed it! -- some pretty narfy infections. (Hey, The First Surgery was required because the infection was so bad it was life-threatening. Are you getting the picture here?)
Are you familiar with the character Catbert -- Evil Human Resources Director from Dilbert? Well, let's pretend to call Wes' first ENT doctor Docbert -- Evil ENT Director. That'll give you an idea. Actually, Docbert was very friendly, and as a person he was likeable. But he did crappy work (I was to discover later). And he attempted to charge an astounding surgeon fee of $14,500 for what is normally a $2,500 job. And his nurse was EVIL. She caused me to cry in physical pain. (And if there's one thing I want you to know from these nose pages it is that no procedure has to hurt. If it hurts, they haven't prepared you properly or are not doing it correctly.) I informed Docbert that he had employed Nurse Ratchet and refused to let her touch me again. But I digress. You can read her transgression in The First Surgery.
Well Docbert put a small hole (technically called a "window") way in back of my nose, beyond a turbinate that makes it hard to get to. (See "old hole" in the picture for location.) This crappy location is a Bad Thing.
As you might guess, this additional -- but essentially unusable -- hole did little good.
Wes' second surgery involved a totally different area, the sinuses up above and behind the eyebrows.
The third surgery was in the same general area as the first, but this time creating a hole that was useable. (At this point, the hole doubles from the size of the first surgery.)
The fourth surgery put a big new window ("Texas Size" -- about four times the size of what was there by surgery #3) right up front where it says "new hole" in the picture, below. The hope is that more gunk will flow naturally, and that with easier access to Wes' maxillary sinuses, Dr. Kosoy can get future infections out with his suction and other equipment.
Points of interest
Translations of terms used above
- agger nassi -- the ridge of the nose
- anterior -- before or in front of
- carotid -- pertaining to the right and left common carotid arteries, both of which arise form the aorta, and are the princial blood supply to the head and neck.
- concha nasalis -- one of the three scroll-like bones that project medially from the lateral wall of the nasal cavity; a turbinate bone.
- ethmoid sinus -- air cells or space inside the ethnoid bone, opening into nasal cavity. The "ethnoid bone" is the "sievelike spongy bone that forms a roof for the nassal fossae and part of the floor of the anterior fossa of the skull. It contains a number of thin-walled cellular cavities, the ethnoidal cells, which are arranged in three groups. They open into the nasal cavity.
- fossa -- a furrow or shallow depression
- olfactory -- pertaining to smell
- posterior -- toward the rear or caudal end
- sphenoid -- "wedge shaped." In ENT terms something relating to the "sphenoid" relates in some form to the sphenoid bone, "a large bone at the base of the skull between the occiptal and ethmoid in front, and the pareital and temporal bones at the side. (Simpler: The area formed between, slighty above, and behind the eyebrows.)
- turbinate -- see concha nasalis