322 NECROSIS OF THE TURBINATED BONES. 



directly seen, or felt by the finger. As swelling of the pharyngeal 

 glands is usually present, the condition is sometimes difficult to dis- 

 tinguish from nasal polypus, and is occasionally only recognised 

 exactly after trephining. 



Treatment. Trephining the nasal cavity and removal of the 

 diseased turbinated bone is the only method likely to prove successful. 



Cadiot and Dollar describe removal of the posterior (maxillary) 

 turbinated bone. The left nasal cavity was trephined, an incision about 

 | of an inch long being made opposite the centre of the nasal bone ; at 

 each end two circular trephine openings were made and the intervening 

 bone removed with scissors. The anterior part of the diseased bone was 

 removed through an opening in the left false nostril and the remainder 

 through the trephine incision. In four weeks recovery was almost 

 complete. Hoyer, in a case of necrosis of the turbinated bones, removed 

 the diseased part with a muscle hook and secured healing, whilst the cases 

 described by Jessen were also cured by resection of the diseased turbinated 

 bone through a trephine opening. Hering and Jessen recommend making 

 an incision through the skin close to the middle line, and extending the 

 entire length of the nasal bone. At the upper end of this cut the trephine 

 is inserted, and a piece of the nasal bone an inch broad and as long as the 

 cut through the skin removed by a key-hole saw. Through such an 

 incision the diseased turbinated bone could also be removed. But a case 

 of caries treated in this way by Moller was still uncured after the lapse 

 of eight weeks. Complete resection of the turbinated bones is attended 

 with no slight difficulty ; any fragments left behind are apt to continue 

 the disease. Schlegel described a case in a horse of osteosarcoma of the 

 left lower turbinated bone, which eventually led to pulmonary gangrene 

 and metastatic growths, endocarditis, gastritis ulcerosa, and tendovaginitis 

 of the flexor tendons of botli hind-legs. The animal died. A horse treated 

 by Cadiot for necrosis of the turbinated bones died of consecutive 

 meningitis and pyaemia. 



Sand recommends, in cases of mucoid degeneration of the turbinated 

 bones, to trephine early, and having established free drainage, to wash 

 the parts out regularly with antiseptic solutions. This is said usually 

 to check or completely cure the disease. A four-year-old mare was sent 

 to hospital after suffering for some weeks from ill-smelling nasal discharge. 

 She was well-nourished, and had no appearance of bodily illness, but an 

 offensive muco-purulent discharge, smelling of bone pus, was discharging in 

 moderate quantities from the left nostril ; the submaxillary glands of the 

 left side were somewhat swollen. The use of Gunther's catheter disclosed 

 the existence, on the floor of the left meatus, of a slight unevenness and 

 swelling at the height of the third molar. The resulting examination of 

 the mouth disclosed the fact that the third upper molar on the left side 

 had lost its crown, and that all the appearances of purulent periostitis 

 of the alveolus existed. Scars left by the previous trephinings were visible 

 on the temporal and superior maxillary bones of the left side. After 

 removing the diseased tooth by punching, the operation wound healed 

 regularly, but the nasal discharge continued. Trephining the nostril was 

 undertaken, when it was found that the turbinated bones were necrotic, 

 and denuded of mucous membrane at several points. Attempts to remove 



