334 OPERATIONS ON THE DIGESTIVE APPARATUS. 



complicated with lesions of the nasal cavities, when the ulcerating 

 j)rocess has been followed by a perforation between one or other 

 of these cavities and the mouth. This lesion is accompanied by a 

 discharge taking place on the side of the nose corresponding to 

 that of the diseased tooth. This discharge is of a muco- purulent 

 character, and mixed with saliva and food, which gives it the 

 usual foetid odor as well as a peculiar green aj^pearance. It is 

 very different from that belonging to glanders, and is too charac- 

 teristic to justify by its presence an error in diagnosis in that 

 direction. If, however, the same comj)lications take j)lace in the 

 molars, whose roots rest on the sinuses of the head, the symp- 

 toms which are manifested are often so nearly similar in aspect 

 to those of chronic glanders, that the commission of an error 

 should not be considered wholly inexcusable. Carefiil examina- 

 tion will readily bring out the differential diagnosis between the 

 two diseases, though so different in their ensemble. When the 

 caries of one of these last molars exists to such an extent as to 

 transform the mucous membrane of the sinuses into a sup- 

 j)urative surface, and to cause the development of granulations 

 upon its surface ; or to allow the collection of pus in the cavity of 

 the sinuses, a discharge becomes established through the nostril 

 of the side of the diseased tooth and affected sinus. This dis- 

 charge is white, grumous, very abundant, and keej^s increasing, 

 and has also an extremely foetid odor, identical with that of dental 

 caries. 



The lymphatic glands of the maxillary space then become 

 swollen, hard, though painless, and loose under the fingers. The 

 jDlates of the zygomatic, of the superior maxillary and of the 

 nasal become swollen, and give a dull sound on percussion. 

 Sometimes their surfaces are so thinned out that it flexes under 

 the pressure of the fingers, and they are then surrounded by an 

 oedematous infiltration of subcutaneous cellular tissue. 



The long and minute consideration which we have thus given to 

 the diseases of the dental apparatus has been principally devoted 

 to the molar teeth of herbivorous animals, although many of the 

 conditions observed in the grinders may also be found belonging 

 to the incisors. Indeed, incisor arches may also offer abnormah- 

 ties in the number of teeth, in theu' position, and in the direction 

 or the length of these organs, and they may also become the seat 

 of accidental lesions, such as fractures, luxations, or the too 



