TREPHINING OF THE FACIAL SINUSES. 



17 



malignant growths in the old, foreign bodies in the sinuses, 

 differential diagnosis of diseases of this region, etc. 



Veterinarians trephine the sinuses by two fundamentally 

 different plans ; with, and without excision of the cutaneous 

 disk corresponding to the piece of the bone removed. The 

 first is generally used in Great Britain and North America, 

 while the last is the prevailing method in continental 

 Europe and other parts of the world. The reason assigned 

 for these variations in method are conflicting. To us there 

 seem to be adequate reasons for preferring the excision of 

 the cutaneous disk. We regard as the chief considerations 

 in an operation the following : the avoidance of infection ; 

 the prevention of pain during the operation or the after- 

 treatment ; the reduction of the scar to a minimum ; rapidity 

 and certainty of recovery ; convenience in operating and 

 dressing. Inevitably a septic operation, the degree of 

 infection is largely dependent upon the area of the wound, 

 the facility for maintaining cleaniness and the degree of 

 disturbance to the tissues while being dressed. The wound 

 area in the bone is alike in all cases but that in the skin 

 varies greatly. If we compare the usual European technic 

 with that given below we would find the wound area ap- 

 proximately 2.2 sq. in. in the European method, while in 

 the latter we have only about .44 sq. in. or proportionately 

 the wound area in the soft tissues in the two operations 

 would be as 5 : I . 



It is very evident that the technic given below affords 

 immeasureably better facility for maintaining cleanliness in 

 the wound and with a minimum amount of insult to the 

 tissues in the process of dressing. 



The amount of pain caused in the operation which should 

 be eliminated by local anaethesia depends chiefly upon the 

 extent of the skin incision which is essentially equal in the 

 two plans .so that the only difference would be in the 



