72 
TREPHINING THE SUPERIOR MAXILLARY SINUS. 
inspiration of blood the horse is at once allowed to rise; for a similar 
reason anaesthetics are withheld. 
During the first three or four days after operation the artificial opening 
may remain closed with blood or pus, but at the end of that time discharge 
occurs freely and recovery is usually easy. 
After-treatment must depend on the nature of the diseased processes. 
In chronic catarrh, flushings of the affected sinus, with antiseptics like 
2 per cent, carbolic solution, are indicated. Where putrefactive pro¬ 
cesses are actively going on, 8 per cent, permanganate of potash, or 
solutions of astringent materials—such as alum 2 per cent., tannin 
2 per cent.—may be used. The opening is then closed with a plug, so 
as to guard the mucous membrane against the direct influence of the 
• air. Treatment should be continued as long as any nasal discharge is 
present. The wound is afterwards encouraged to heal, only soft plugs 
being used in the trephine opening. In about three or four weeks it 
closes completely, and after the lapse of two or three months scarcely a 
trace of the operation can be observed. Where large tumours are to be 
removed from the frontal or superior maxillary sinuses a simple opening 
may not be sufficient; a second is bored in the neighbourhood of the 
first, and the intervening bone removed with the assistance of the 
chisel (fig. 48) and the hammer. Holler has frequently had occasion 
to trephine the nostril in this way in order to remove tumours or 
necrotic portions of the turbinated bones. A saw similar to a key-hole 
saw is useful here in order to enlarge the trephine opening. 
Although diseases of the frontal sinuses occur in herbivora, they are 
less common than in horses. In sheep, on the other hand, the presence 
of oestrus ovis may necessitate the opening of the frontal and maxillary 
sinuses. This is usually done in the middle line, in order that both 
sides can be opened simultaneously, and washed out by injections. The 
frontal sinus, as in other ruminants, is connected with the horn-core, 
and may be opened by sawing through the horns ; but this operation 
is not only more painful, but is also accompanied by greater loss of 
blood, which in cattle already weakened may be attended with undesirable 
consequences. 
(5) NECROSIS OF THE TURBINATED BONES. 
After Jessen’s description of a peculiar disease of the turbinated bones 
of the horse, accompanied by chronic thickening, Stockfleth and others 
published descriptions of similar cases. The condition is not common 
in North Germany, and usually appears after strangles, while a few 
cases of Holler’s have been caused by disease of the upper molars. 
Sand, on making the post-mortem examination of an old horse which 
