TUMOURS IN THE FACIAL SINUSES AND CANCER OF THE SUPERIOR MAXILLA. 25 



side of the face, a hard, diffuse, shghtly painful tumour, without 

 enlargement of the corresponding submaxillary space. A purulent 

 discharge escaped from the left nostril. On examining the cavity of 

 the mouth we only noted a trifling swelling of the mucous membrane 

 on each side of the line of molars. The horse being old and used was 

 slaughtered. Post-mortem examination showed that the sinuses of the 

 left side were to a great extent filled by this tumour. 



I confine myself to merely mentioning melanotic and mycotic 

 tumours, which in exceptional cases may be met with in the sinuses. 



I now arrive at an extremely grave form of secondary tumour 

 occurring in these cavities : I mean epithelioma. The history of 

 a few patients will doubtless fix in your minds the symptoms and 

 malignity of these tumours. 



Towards the end of last year, a ten-year-old horse was brought 

 here by a man who had bought it a few days before. He had noted 

 that the cheek was swollen, that the animal had a discharge from the 

 left nostril, and that it ate with difficulty, symptoms which he thought 

 would be cured by a few applications of the tooth rasp. 



The animal's general condition was good, though it showed some 

 depression, and the face indicated suffering. Attention was specially 

 arrested by a curdled stinking discharge from the nose, and by strings 

 of saliva running from the mouth. On examining the cavity of the 

 mouth, the nature of the condition was easily recognised. Unfor- 

 tunately, it was not at all what the owner had thought. The buccal 

 cavity contained a large tumour, involving the hard palate, and 

 extending the entire length of the left upper row of molars. It 

 projected slightly above the level of the mucous membrane, so that its 

 anterior boundary opposite the second molar was clearly distinguish- 

 able. Other points were made out by inserting a gag, and artificially 

 lighting the mouth. The last left molars, partially buried in exuberant 

 granulations arising from the new growth, were already loose. The 

 prominence formed by the tumour was only pronounced in the neigh- 

 bourhood of the molars ; over the greater part of the hard palate it 

 was scarcely noticeable. The mucous membrane appeared simply to 

 be covered by a kind of granular membrane. The lower nasal cavity 

 was deformed, its floor bulged upwards owing to pressure exercised by 

 the tumour. The latter extended to the interior of the maxilla, but 

 had principally developed in the mouth and sinuses. Another impor- 

 tant symptom consisted in swelling of both submaxillary glands, a 

 condition strongly indicating the nature of the new growth. The sub- 

 maxillary gland on the left side formed a bosselated very hard mass. 



