74 
NECROSIS OF THE TURBINATED BONES. 
made opposite the centre of the nasal bone ; at each end two circular trephine 
openings were made and the intervening bone removed with scissors. The 
anterior part of the diseased bone was removed through an opening in the 
left false nostril and the remainder through the trephine incision. In four 
weeks recovery was almost complete. Hoyer, in a case of necrosis of the 
turbinated bones, removed the diseased part with a muscle hook and secured 
healing, whilst the. cases described by lessen were also cured by resection of 
t le diseased turbinated bone through a trephine opening. Hering and 
lessen recommend making.an incision through the skin close to the middle 
line, and extending the entire length of the nasal bone. At the upper end of 
t cu ^ ^ le trephine is inserted, and a piece of the nasal bone an inch broad 
and as long, as the cut. through the skin removed by a key-hole saw. Through 
such an incision the diseased turbinated bone could also be removed. But a 
case of caries treated in this way by Moller was still uncured after the lapse 
ol eight weeks. Complete resection of the turbinated bones is attended with 
no slight difficulty; any fragments left behind are apt to renew the diseased 
processes . Schlegel described a case in a horse of osteosarcoma of the left 
ower turbmated bone, which eventually led to pulmonary gangrene and 
metastatic growths, endocarditis, gastritis ulcerosa, and tendovaginitis of the 
flexor tendons of . both hind legs. The animal died. A horse treated by 
Cadiot for. necrosis of the turbinated bones died of consecutive meningitis 
and pyaemia. & 
Sand recommends, in cases of mucoid degeneration of the turbinated 
bones, to trephine early, and having established free drainage, to wash the 
parts out regularly with antiseptic solutions. This is said to usually check or 
completely cure the disease. In August, 1888, a four year old mare was sent 
to hospital after suffering for some weeks from ill-smelling nasal discharge, 
bhe was well-nourished, and had no appearance of bodily illness, but an 
offensive muco-purulent discharge, smelling of bone pus, was discharging in 
moderate quantities from the left nostril; the submaxillary glands of the left 
side were somewhat swollen. The use of Gunther’s catheter disclosed the 
existence, on the floor of the left meatus, of a slight unevenness and swelling 
at the height of the third molar. The resulting examination of the mouth 
disclosed the fact that the third upper molar on the left side had lost its 
crown and that all the appearances of purulent periostitis of the alveolus 
existed, bears left by previous trephinings were visible on the temporal and 
superior maxillary bones, of the left side. After removing the diseased tooth 
by Punching the operation wound healed regularly, but the nasal discharge 
continued. Trephining the nostril was undertaken, when it was found that 
the turbinated bones were necrotic, and denuded of mucous membrane at 
seveia points. Attempts to remove these portions were not successful; and 
on account of the comparatively small value of the horse, the owner decided 
to nave it killed. 
Necrosis of the cartilage of the nostril is described by Cadiot and Dollar 
( Clinical veterinary Medicine and Surgery,” p. 315). The inner wing of the 
nostril was swollen and indurated over the region corresponding to the 
cartilaginous plate, with which a sinus, masked by granulations, communi- 
cated. Ihis smus was laid open and the parts swabbed with iodine tincture. 
1 reatment was intermittent and a second operation became necessary but 
recovery occurred m four months. J 
