[The maxillary sinus and its illness in the history of rhinology. Images from the history of otorhinolaryngology, highlighted by instruments from the collection of the German Medical History Museum in Ingolstadt].

ANATOMY

In ancient times the paranasal sinuses, without any anatomical differentiation, were thought to be a system of hollow spaces through which mucus produced by the brain was drained. Leonardo da Vinci in Milano in 1489 was the first to prepare and draw anatomical specimens of the paranasal sinuses; the drawings, however, only became accessible to scientific evaluation as late as 1901. N. Highmore in England in 1651 presented the first detailed description and drawing of the maxillary sinus, and hence it is named Highmore's antrum. C. V. Schneider in Wittenberg, Germany, in 1660 realized that the mucus is not a product of the brain but is produced by the mucous lining of the region itself. F. G. J. Henle in Berlin in 1841 differentiated between various epithelia and described the special function of the ciliated epithelium of the respiratory tract.

FROM OZENA TO SINUSITIS

In ancient times the word ozena originally denoted any kind of foul breath, but in the 1st and 2nd century AD (Celsus, Galenus) the term became restricted to foul odor coming from the nose. J. Drake and W. Cowper in England in 1707 reported that in some cases ozena was due to suppuration in the maxillary sinus and could be cured by extraction of a tooth and opening the sinus via the alveolus. L. H. Runge in Rinteln, Germany in 1750 compiled a nearly complete systematic survey of all diseases localized in the maxillary sinus.

EARLY STAGES OF SURGERY

A. L. B. B. Jourdain in France in 1765 tried to cure suppurations of the maxillary sinus by irrigation via the natural ostium in the middle nasal meatus, however, his method did not meet with approval. L. Lamorier in Montpellier in 1743 opened the maxillary sinus form the buccal cavity, but his paper was only published in 1768. Lamorier's method and opening the sinus via a dental alveolus remained standard procedures for a long time. K. Ziem in Danzig, Germany, in 1886 analyzed 26 cases of chronic suppurations discharging from the nose, among them his own history, and found out that they can originate from different foci and that the treatment must be centered around the relevant focus.

CLASSICAL OPERATIVE PROCEDURES

J. Mikulicz-Radecki in Vienna in 1886 was the first to open the maxillary sinus from the inferior nasal meatus. G. W. Caldwell in New York in 1893 published his method: opening the canine fossa wall, removal of the mucous membrane, and opening a window in the lateral wall of the inferior nasal meatus. G. Boenninghaus in Breslau, Germany, in 1896 was the first in Europe to adopt this method, and he modified it by placing a mucosal flap in the window. Unaware of Caldwell's publication, H.-P. Luc in Paris in 1897 reported on his own operative procedure, which in fact was identical to that of Caldwell's.

DEVELOPMENT DURING THE LAST 100 YEARS: The operative procedures and especially the preoperative diagnosis were continually improved so that the surgical treatment of chronic suppurations of the maxillary sinus reached a high standard. During the last decades less radical interventions using an endonasal approach by endoscopy have partly superseded the classical procedures. This development is described in great detail with literal quotations of the original papers, anecdotal details, and illustrations.