170 VETERINARY SURGICAL OPERATIONS 



ophytes are seen to be much more unfavorable conditions for 

 neurotomy than the old or more diffused lesions of the same 

 cl.ass. The lameness of ringbone may be marked without dis- 

 tracting from the results, but in no case should the operation 

 be performed when the lameness is acute or changeable. 



Sesamoiditis. — Inflammatory conditions localized in the 

 sesamo'idean apparatus, — sheath, bones or ligaments, — of 

 known chronicity, are ideal indications for median neurot- 

 omy. The cure of the lameness from such lesions is an abso- 

 lute certainty in almost every case. The median nerve seems 

 to supply the sensation for this region. The ulnar nerve 

 seems to have relatively less influence in the sesamoidean 

 apparatus than in the other structures it assists the median 

 to supply. It is essential that the process be chronic, and 

 preferable that it be confined to the internal aspect of the re- 

 gion. Diffuse sesamoiditis, however, yields to the operation 

 in almost every instance, but if any lameness remajns the 

 ulnar operation will perfect the cure. 



Sidebones. — Unilateral sidebones are best treated with 

 unilateral high plantar neurotomy, but it sometimes happens 

 that the internal one is large and the external one small, or 

 that the former causes proportionately more of the lame- 

 ness than the latter. In this event median neurotomy is ad- 

 visable over the bilateral plantar operation because some of 

 the sensibility of the foot is retained. 



CONTRA-INDICATIONS.— Median neurotomy should 

 not be performed with impunity in any case whatever, as 

 there is always some danger of wrenching some of the liga- 

 ments of the diseased part, of loss of the hoof, or of aggra- 

 vating the lesion, whatever its location or character may be. 

 It must be appli-ed with the same respect for the limitations 

 governing all the neurotomies. Acute, new, serious, aggra- 

 vated or highly painful diseases constitute so many forbid- 

 den conditions. In these states there must be no excep- 

 tions, and the feet, like in plantar neurotomy, should be of 

 good quality and conformation, free from threatening corns 

 or traces of chronic deforming laminitis. The legs and the 

 feet should be strong, and capable of performing their sev- 

 eral functions after the pain no longer acts to protect them 

 against injury. A serious sesamoiditis is more likely to ter- 

 minate badly than any of the other diseases for which the 

 operation is performed. Very often the fetlock will become 

 painful, swollen and hot as soon as the horse is put to work. 

 The sesamoidean ligaments are torn from their attachments 

 and the whole region becomes the seat of a serious diffused 



