IV.— TUMOURS IN THE FACIAL SINUSES AND CANCER 

 OF THE SUPERIOR MAXILLA. 



You recently saw in the external clinique a patient with a tumour 

 of the sinuses and of the bones of the face, on which I refused to 

 operate. I wish to explain to you this morning the reasons for my 

 abstention, and for that purpose shall take as my subject ''New 

 Growths in the Sinuses." 



Although much less frequent than catarrhal inflammations of the 

 mucous membrane, or simple inflammation of the sinuses, new growths 

 in the sinus are, nevertheless, not ver}^ rare. I have collected a fair 

 number of cases, differing considerably from one another in regard to 

 the nature of the lesions and to their gravity. 



In the sinuses of the horse one meets with cysts, myxomata, 

 fibromata, sarcomata, and epitheliomata. 



I will shortly relate some clinical cases, which will give you an idea 

 of the symptoms, course, and prognosis of these various tumours, and 

 will show you within what limits intervention is permissible. 



Let us first of all consider the cysts. 



In 1893 a Percheron horse, seven years old, was sent to the clinique 

 on account of a discharge from the left nostril of two months' standing. 

 The discharge was thick, grumous, and offensive. On the left side 

 the submaxillary gland was slightly enlarged, and felt like a little 

 bunch of grapes, the constituent portions, however, being moveable one 

 over the other. The external wall of the sinuses was slightly raised, 

 and sensitive on percussion ; the sound given was distinctly dull. I 

 concluded that suppuration was occurring in the sinuses. An explo- 

 ratory puncture confirmed the diagnosis, and the patient was left in 

 hospital for treatment. 



Having trephined the parts, we found in the inferior maxillary 

 sinus, along with a considerable quantity of pus, several small, soft 

 tumours developed from the mucous membrane. In the frontal and 

 superior maxillary sinuses the mucous membrane was simply thickened 

 by inflammation. The teeth were normal, the maxilla was not 



