20 TREPHINING OF THE FACIAL SINUSES. 



section of the skin from the bone in the German operation. 

 Tlie pain caused in dressing mnst be greater in the German 

 metliod because the detached, overhanging skin must be 

 moved and disturbed each time causing pain and inviting 

 infection. The question of pain must always be seriously 

 considered as it not only affects the time required for dressing 

 and its efficacy, but has aji important relation to the docility 

 of the animal after recoveiy, some horses having their dis- 

 positions permane7itly ruined by the i7'ritatio7i 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 yi" to 

 lYi" in diameter on the face does not leave a visible scar so 

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

 tion which we have asserted above is far more probable by 

 the German method. 



The rapidity and certainty of recovery are dependent on 

 considerations above discussed. The removal of the cuta- 

 neous disk is certainly easier and quicker than the other 

 method. The convenience for dressing is evidently superior 

 by the English and Amercan method. 



The opening of the maxillary sinuses into the no.strils is 

 based upon the surgical principle that suppurating cavities 

 should be provided with ample drainage from the nio.st de- 

 pendent part. The direction to leave the external wound 

 open may at first thouglit seem antagonistic to general sur- 

 gical principles but it should be remembered that the wound 

 consi.sts only of the incision through the skin, connective 

 tissue and bone and that any plug which we can put in this 

 opening can only .serve to dam the secretions of the cavity 

 b.ack and can not prevent it from coming in contact with the 

 wounded .surface. It must further be regarded that the 

 respiratory mucosa of the upper air passages are not irritated 

 or injured in any manner so far as we can observe clinically 

 by the direct admission of air into them through a trephine, 

 or other artificial opening. 



