The accompanying illustration shows a new sinus Punch in two sizes, 4 and 6 mm. barrels and cutting edges, changeable, right, left, up and down, with three combined advantages:
1. It is small enough to get into the nose without causing trauma to septum or turbinates. age, as the small punch can be passed under the middle and inferior turbinates. This is a great advantage in atrophic rhinitis, in which one wants to save the turbinates, and in acute sinusitis. When necessary to use the larger punch, some of the turbinates will have to be sacrificed.
3. The cutting edge cuts in every direction so the opening can be enlarged in direction of least resistance. Mounted on a small barrel it gives a compact but strong instrument.
This instrument is the result of my many failures to open the sinuses so as not to destroy more of the turbinates than