."J 14 DISEASE OF THE FACIAL SINUSES. 



was accidentally dropped broke into three pieces ; the fractures 

 were clean and conchoidal, giving one the impression that this large 

 tumour had resulted from the fusion of several of small size. The 

 smaller tumour included in its structure a molar tooth. — The 

 Veterinarian, March, 1899. 



In sheep oestrus larvae sometimes cause disease of the frontal 

 and superior maxillary sinuses. In dogs tumours are the commonest 

 cause, though Linguatula tsenioides occasionally plays a part. 



The diagnosis can often be made only by the method of elimina- 

 tion. The first symptom is a one-sided mucopurulent and sometimes 

 ill-smelling nasal discharge, which may only appear at intervals or 

 when the head is depressed, as in disease of the guttural pouch. If 

 the disease has been caused through alveolar periostitis, the peculiar 

 odour of a decayed tooth will be notable. The submaxillary glands 

 of the same side often swell, and the case may be suspected to be 

 glanders. At a later stage the bones inclosing the sinus become 

 swollen, and on percussion over the diseased spot emit a less resonant 

 sound. In making this test the horse's mouth must be closed, and 

 the sinus on each side struck in turn over exactly corresponding 

 points, using the plain end of the percussion hammer, or the points 

 of two fingers. Thinning of the bone, so that it yields to strong 

 pressure, is sometimes seen in cases of tumour growth and in 

 actinomycosis or botryomycosis. Perforation or bulging of the bone 

 is only seen in rare cases, and is generally due to tumour formation. 

 In doubtful cases resort may be had to exploratory puncture by 

 means of a gimlet. 



In oxen the nasal discharge is usually blood-streaked at first, 

 and only becomes purulent at a later period. If the frontal sinus 

 be affected, signs of brain disturbance, like dulness, lowering of the 

 head, giddiness, falling or staggering may appear. In unilateral disease 

 the animal usually holds the head obliquely towards the diseased side. 



Similar sensory disturbance is seen in dogs and sheep when the 

 frontal sinuses are affected. Dogs are then apt to be very snappish. 



Treatment must be preceded by trephining. Though two openings 

 are not absolutely necessary in every case, it is usual to trephine 

 both the frontal and superior maxillary sinuses. To provide drainage 

 the superior maxillary sinus must be opened, but the only useful 

 purpose served by opening the frontal sinus is to allow of the cavities 

 being thoroughly washed out, which is very essential in all cases of 

 empyema. Inhalations or insufflations are useless in impaction of 

 the facial sinuses. The cases said to have been cured by disinfectant 

 sprays or powders are open to considerable doubt. 



