618 DISEASES AND INJURIES OF THE FACIAX REGION. 



tures 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 tlie 

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

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

 'slight enlargement over tlie 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- 

 iporal arteries of the side affected may also throb niore or less. 



"These symptoms are diagnostic of disease of the sinuses of 

 Ithe head, and are, I think, sufhcient to induce the practitioner to 

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



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

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

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

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

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

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

 ithe spot containing the pus. 



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

 e.xi)loring 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 

 trepliining, where no pus Avas contained in the sinuses. 



I quite agree with Professor Varnell that the proper place for 

 trephining the sinuses, in order to remove anything 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, vai^'ing, 

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

 he is young, it must be considerably nearer to the .caA-ity of the 



