TREPHINING INFERIOR MAXILLAR Y SINUS. 4 1 



causes intense pain and renders the animal very resistant to 

 the necessary manipulations in the after care of the wound 

 and may leave the patient pernamently nervous about the 

 handling of its face. 



Hemorrhage is generally not severe and may occur from 

 the skin, where it may be readily controlled by compression 

 or ligation ; from the intra-osseous vessels, where it may 

 be checked by pressure with absorbent cotton, by pushing 

 a small portion of cotton into the channel of the vessel 

 with a needle or tenaculum or by plugging the vessel with 

 a conical piece of wood ; from the wounded turbinated 

 bones where it may be stopped by packing with gauze. 

 These tampons should be removed after twenty-four hours. 



5. TREPHINING THE INFERIOR MAXILLARY SINUS. 

 Plates III XI. 



Uses and Instruments. Same as in the preceding. 



Anatomical Outline. The inferior maxillary sinus is 

 an exceedingly irregular cavity, differing in details of form 

 and extent in individuals and at various ages. As shown 

 in the illustrations its disposition might be compared to a 

 pair of saddle bags hanging over the nerve conduit, the 

 lateral and median chambers not very unlike in extent. 

 As suggested in Plates IV-V, the floor of the lateral cavity 

 is broken up by irregular bony septa, which in some cases 

 cut the sinus up into quite separate cavities. Sometimes it 

 extends downwards barely below the end of the zygoma, 

 at other times it reached down below the infra-orbital 

 foramen. There is hence no rule by which the operator 

 may at all times make his opening precisely at the lower 

 extremity of the sinus. 



Technic. The general technic is the same as for the 

 frontal and superior maxillary sinuses, but two trephine 



