II.— PURULENT COLLECTIONS IN THE FACIAL 

 SINUSES AND DENTAL CARIES. 



During the years i8g6 and 1897 eighteen horses affected with 

 collections of pus in the sinuses were trephined in the hospital. 

 According to the nature or cause of the disease, these eighteen cases 

 may be divided as follows : — Simple inflammation of the sinuses, 

 four ; inflammation of the sinuses produced by tumours, five ; inflam- 

 mation of the sinuses of dental origin, nine. 



The small number of cases of simple inflammation is truly striking. 

 This may possibly be due in part to the fact that the animals sent to 

 us are those regarded by ordinary practitioners as unpromising, but I 

 believe the number of cases of secondary inflammation of the sinuses 

 is in reality greater than is generally supposed. In addition to dental 

 caries and to true tumours one sees diffuse myxomatous degeneration 

 of the mucous membrane of the sinuses. 



In all the cases of inflammation of the sinuses due to new growths 

 the tumours were malignant or beyond operation. I therefore confined 

 myself to trephining and verifying diagnosis. 



In the cases of dental origin, treatment consisted in trephining 

 the maxillary and frontal sinuses, afterwards enlarging the lower ori- 

 fice and removing the diseased molars by punching. After cleansing 

 the parts I plugged the alveolar cavity with gauze and cotton wool ; 

 this dressing was renewed every twenty-four or forty-eight hours ; the 

 sinuses were cleansed and irrigated as in cases of simple collections of 

 pus. The results have been good. Of nine horses thus treated six 

 were cured in a month to six weeks. 



The alveolar cavity does not heal with equal readiness in all cases. 

 In some it fills up slowly, in others with fair rapidity, and these 

 differences are seen in animals of the same age or thereabouts. In the 

 following case closure of the cavity was particularly rapid. 



In November, i8g6, I had to punch out the third and fourth upper 

 molars of a seven-year-old mare. The large communicating space 

 between the mouth and sinus was plugged with gauze and wadding. 



