Nasal Sinuses, position, orifice, suppuration, symptoms, treatment,
tonics, astringents, antiseptics, trephining, significance of the
fœtor, mode of recovery.
In severe _coryza_ the nasal sinuses become implicated as shown by the
intensity of the symptoms, the prostration, the hanging head, and the
heat and sometimes tenderness between the eyes and immediately beneath
them on the side of the upper jaw. These sinuses are large spaces filled
with air, situated between the superficial and deep plates of the bones
of the face and opening into the nostrils by a narrow orifice in the
upper part of the nasal chambers. When pus is largely formed in these it
fails to flow out as rapidly as produced, parts with a portion of its
liquid elements, increases in consistency and sometimes even undergoes
decomposition, so that the discharge from the nostril has a putrid odor.
The most distinctive symptoms of this form of _nasal gleet_ are obtained
by percussing the sinuses, and in those cases in particular in which the
accumulation is confined to one side of the head, the contrast between
the two sides is unmistakable. By gently tapping the forehead with the
middle finger from one eye to the other the flat solid sound on the
diseased side is easily distinguished from the clear drum-like resonance
on the healthy one. By tapping on the bone beneath each eye and just
above the ridge on the side of the upper jaw, the difference between the
two sides will be recognized in the same way. In some old standing cases
increased tenderness and slight bulging of the bones over the affected
sinuses are often superadded to the other symptoms. The eye on the
affected side is usually retracted so as to seem smaller.
_Treatment._ In some cases the use of tonics and astringent injections
as recommended for the treatment of _ozœna_ will prove successful, but
more usually it is needful to open and inject the sinuses.
For this the following articles are required: scissors, a knife,
forceps, a trephine or circular saw from half to three-fourths of an
inch in diameter and a whalebone or metallic prob.
The horse is thrown and made fast with the diseased side of the head
uppermost. A point is then selected on a line drawn between the centres
of the two eyeballs and an inch to one side the median line of the
forehead; the hair is closely removed with the scissors, and a
semi-circular flap of skin over an inch in diameter is dissected from
the bone and turned back toward the poll. The trephine is next applied
on the bone and a circular portion, having been cut through, is pulled
out by the forceps, when the imprisoned pus will commonly ooze from the
opening. A second point is chosen just above the lower end of the bony
ridge of the upper jaw already referred to and opposite the third molar
tooth, counting from before; the hair is removed as before, a flap of
the skin raised upward and backward and the bone trephined to open the
second sinuse. The point of election for this orifice is more important
than that of the first. If it is too near the eye the lower part of the
sinus, which is separated from the upper by an imperforate bony plate,
is not opened and may continue to keep up the discharge from the nose.
If on the contrary it is made too low down, the lower sinuse only is
opened and the upper being imperfectly washed out from the wound in the
forehead will keep up the discharge. Either then this plate must be
struck with the trephine or it must be afterward perforated to secure a
favorable result. The prob introduced by the wound in the forehead
should further appear at the lower orifice.
The cavities are to be washed out first with clear tepid water, and
thereafter daily with an astringent solution such as that used for
injecting the nose. If the discharge does not escape freely by the lower
orifice its exit may be facilitated by drawing a tape through the
sinuses, from the upper to the lower, and retaining it there by a knot
on each end.
Marked fœtor of the wound will usually indicate necrosis at the edge of
the wound, and demands the use of bone forceps or chisel to remove the
offending bone.
A cure is affected by the restoration of the membrane to its natural
state, or in other cases by the filling up and obliteration of the
cavity by granulation.