20 TREPHINING OF THE FACIAL SINUSES. 



section of the skin from the bone in the German operation. 

 The pain caused in dressing must be greater in the German 

 method because the detached, overhanging skin must be 

 moved and disturbed each time causing pain and inviting 

 infection. The question of pain must always be seriously 

 considered as it not only affects the time required for dressing 

 and its efficacy, but has an important relation to the docility 

 of the animal after recovery, some horses having their dis- 

 positions permanently ruined by the irritation due to the oft 

 repeated painful dressing of wounds. 



The cicatricial contraction of the tissues of the horse is 

 so great that the removal of a circular disk of skin "/%" to 

 i%" in diameter on the face does not leave a visible scar so 

 that the question of blemish falls back upon that of infec- 

 tion which we have asserted above is far more probable by 

 the German method. 



The rapidity and certainty of recovery are dependent on 

 considerations above discussed. The removal of the cuta- 

 neous disk is certainly easier and quicker than the other 

 method. The convenience for dressing is evidently superior 

 by the English and Amercan method. 



The opening of the maxillary sinuses into the nostrils is 

 based upon the surgical principle that suppurating cavities 

 should be provided with ample drainage from the most de- 

 pendent part. The direction to leave the external wound 

 open may at first thought seem antagonistic to general sur- 

 gical principles but it should be remembered that the wound 

 consists only of the incision through the skin, connective 

 tissue and bone and that any plug which we can put in this 

 opening can only serve to dam the secretions of the cavity 

 back and can not prevent it from coming in contact with the 

 wounded surface. It must further be regarded that the 

 respirator)' mucosa of the upper air passages are not irritated 

 or injured in any manner so far as we can observe clinically 

 by the direct admission of air into them through a trephine, 

 or other artificial opening. 



