16 TREPHINING THE FACIAL SINUSES 



area approximately 2.2 sq. in. in the European method, 

 while in the other we have only about .44 sq. in., or pro- 

 portionately 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 

 immeasurably better facility for maintaining cleanliness in 

 the wound and 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 

 dissection of the skin from the bone in the European 

 operation. The pain caused in dressing must be greater in 

 the European method because the detached, overhanging 

 skin must be moved and disturbed each time causing pain 

 and inviting infection. The question of pain in dressing 

 must always be seriously considered as it not only affects 

 the time required for dressing and its efficacy, but has an 

 important relation to the docility of the animal after re- 

 covery, some horses having their dispositions permanently 

 ruined by the irritation due to the oft repeated painful 

 dressing of wounds. 



The cicatricial contraction of the tissues of the horse is 

 so great that the removal of a circular disk of skin }i to i}4 

 in. in diameter on the face does not leave a visible scar sc 

 that the question of blemish falls back upon that of infec- 

 tion, which, as asserted above, is far more probable in the 

 continental European method. 



The rapidity and certainty of recovery are dependent 

 upon the considerations above discussed. The removal of 

 the cutaneous disk is certainly easier and quicker than the 

 other method. The convenience for dressing is evidently 

 superior when the English and American method is used. 



The opening of the sinuses into the nostrils is based upon 



