518 DISEASES A.ND INJURIES OF THE FACIAL REGION. 



tiires that may be involved. The submaxillary glands will be 

 tumefied, but loose, in the cellular bed ; or, on the other hand, 

 hard and adherent to the periosteum of the jaw. The horse may 

 appear dull, but tliis symptom is not always present ; the eye on 

 the side of the head affected will look dim, the upper lid will 

 often droop a little, and there may be a rough appearance of the 

 hair over the region of the part diseased. The breath from the 

 nostril of the side affected may be offensive, indicating thereby 

 disease of the bone or decomposition of the contained matter. 

 Mastication may be imperfect, — a defect which points to the 

 teeth. If the malady is of long standing, and the sinuses full of 

 matter, or the disease peculiar in its nature, there may be a 

 slight enlargement over the affected sinus ; or if the disease be 

 of an inflammatory character, there will be pain, and perhaps 

 pitting of the part upon pressure ; and the submaxillary or tem- 

 poral arteries of the side affected may also throb more or less. 



" These symptoms are diagnostic of disease of the sinuses of 

 tlie head, and are, I think, sufficient to induce the practitioner to 

 seek for the precise cause which produced them." — (Varnell.) 



When the sinuses, or a division of them, are filled with pus, 

 percussion, applied to the outer walls, will cause a dull sound 

 to be emitted, and by comparing the sound of the side affected 

 with that of the healthy side, a distinction can be drawn that 

 will be of material assistance to correct diagnosis. In some in- 

 stances there will be a bulging outwards of the bones over the 

 the spot containing the pus. 



In very doubtful cases I have been in the habit of carefully 

 exploring the sinuses by introducing a small gimlet through the 

 outer wall ; if pus be contained therein, the hollow of the gimlet 

 will be filled with it. This will satisfy the practitioner as to 

 whether there is pus or not, but it does not indicate the line of 

 treatment, as some cases have done well in my practice after 

 trephining, where no pus was contained in the sinuses. 



I quite agree with Professor Varnell that the proper place for 

 trephining the sinuses, in order to remove anytliing abnormal 

 that may be contained in them, is at their most dependent part. 



The spot I always select is situated about an inch superior 

 and posterior to the termination of the zygomatic spine, varying 

 the situation anteriorly, according to the age of the patient. If 

 he is young, it must be considerably nearer to the cavity of the 



