32 Catarrh of the Maxillary Sinus. 



perhaps a protrusion of the wall. A fairly characteristic 

 symptom is frequent blowing with violent movements of the 

 head and the expulsion of mucopurulent masses from the nares. 

 The respiration is snoring and accelerated, but it becomes 

 normal again after the removal of the masses of secretion 

 from the nasal cavities, which have accumulated there from 

 the sinus. 



Dogs frequently shake their heads and rub their noses 

 with their front feet. There is also a unilateral seropurulent 

 or mucopurulent nasal discharge, which may be mixed with 

 blood and may be fetid. In the further course the respiration 

 is blowing, due to constriction of the nasal canal. This dis- 

 appears after opening the buccal cavity or after closing the 

 affected side of the nose. Simultaneously with the appearance 

 of respiratory difficulties, or before these occur, a swelling 

 of the infra-orbital region becomes noticeable ; it is tender to 

 pressure, hot and later on fluctuating. If fluctuation has oc- 

 curred, spontaneous rupture takes place with a diminution of 

 the pressure symptoms which may have existed. The opening 

 in the skin closes within a short time, but a new rupture occurs 

 within one to two weeks and a fistula then persists (Hobday). 



Course. With the exception of those cases of catarrh of 

 the antrum of Highmore which are a part of the clinical mani- 

 festations of contagious rhinitis (see pages 11, 15), the affection 

 usually comes on very slowly and it often takes months before 

 it is fully developed. Even after the development of a grave 

 condition the patients remain alive for months and are able 

 to work. Later on, however, perhaps only after years, severe 

 disturbances develop, especially respiratory difficulty, a kind 

 of dumb-staggers, and symptoms of meningitis if the process 

 has invaded the frontal and ethmoidal sinuses. In horses, the 

 inflammation frequently spreads to the mucosa of the lacrimal 

 duct (Plosz), and lacrimation and possibly conjunctivitis occur. 

 The exudate may also l)reak through an alveolar space and so 

 lead to the formation of a fistulous tract. Bone necrosis may 

 finally be observed. Especially in horses cases are often mild 

 and may recover spontaneously (F. Miiller, authors' observa- 

 tion). 



The diagnosis is based upon the presence of a unilateral 

 nasal secretion, unilateral swelling of the glands and the 

 generally existing tenderness of the outer wall of the sinus. 

 A diagnosis can generally be made even if a deformity is not 

 yet present. For the exclusion of glanders, trephining, the 

 mallein test or other immuno-diagnostic tests may be necessary. 

 After opening the sinus, it is possil)le to ascertain whether 

 a simple catarrh is present or whether it is secondary to 

 another primary affection. Very fetid pus creates a suspicion 

 of caries. If the latter is present one can generally detect 



