TREPHINING THE FACIAL SINUSES 15 



tjon of these sinuses in such a manner that the antero- 

 inferior extremity of the superior sinus does not show below 

 and external to the inferior one. The inferior maxillary 

 sinus is inferior in the sense that it is nearer to the nasal 

 opening, so that with the he,ad in a vertical position or in a 

 longitudinal section, the inferior sinus is below the superior, 

 while if the head be placed horizontally or a cross section 

 made, a small portion of the superior sinus may show below 

 the inferior, ^ je 



The uses of trephining are in a measure common to all 

 the sinuses and are chiefly for the relief of empyema of the 

 cavities involved, necrosis of the bony or cartilaginous walls, 

 tumors of various kinds, especially dental in the young and 

 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 reasons 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 reduction of infection to 

 a minimum ; the prevention of pain during the operation 

 or the after-treatment ; the reduction of the scar to a mini- 

 mum ; 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 cleanliness 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 



