Nasal fibrous polypus, connection, form, size, bony distortion,
obstructed breathing, abrasion, ulceration, sloughing, submucous
polypus, structure, degeneration. Symptoms, sneezing, snuffling,
discharge, palpation, bony swelling, tenderness. Treatment, forceps,
hook, ecraseur, knife, saw. Actinomycosis. Sarcoma, Carcinoma.
Consistency, structure, fœtor, glandular swelling. Treatment.
Recurrence. Fatty tumors. Bony tumors: cancellated or compact tissue,
localized or extended. Cysts. Strongyli. Angioma. Varicosity. Color,
obstruction to breathing, hæmorrhage, cicatrization.
These are essentially surgical diseases yet as they induce Chronic
Catarrh they may be profitably noticed here.
I. =Fibrous Nasal Polypus.= These are connected to the mucosa by a
pedicle or broad base, and vary in size from a pea to a mass which fills
the entire nasal chamber, projects from the nostrils and presses outward
the septum and facial bones. At times they weigh one or more pounds.
They may cause whistling or rattling in breathing, or may completely
obstruct the passage of air on the affected side. In time they may cause
bulging or even attenuation and perforation of the bony walls,
projecting through the hard palate or on the face. Sometimes the surface
becomes the seat of granulation, ulceration, or sloughing, causing more
or less fœtor. The large polypi make their main growth forward and
backward, moulding themselves to the form of the chamber, and displacing
the turbinated bones. They commence to grow under the mucous membrane
and as they grow and become more loosely attached they carry this as an
outer covering and pedicle. When incised they show a structure of
interlacing bundles of fibres, with cell elements more or less abundant,
according to the rapidity of growth. Gravitz found amyloid degeneration
of the walls of the blood vessels and mucous follicles and of the
fibres.
_Symptoms_ are difficult breathing, snuffling, a smaller current of air
on the affected side, or none, sneezing, a watery, purulent, bloody, or
fœtid discharge, and the appearance of the polypus when the nasal
chamber is examined in a good light. If beyond reach of vision the
polypus may often be felt by the finger. Care must be taken not to
mistake the red, angry surface of the turbinated bones in Catarrh for a
polypus. If beyond the reach of the finger, the flat sound on percussion
of the nasal and frontal bones on the affected side, and the
persistently diminished flow of air may serve for diagnosis. Tenderness
shown on percussion is common to this and abscess of the sinuses.
_Treatment._ The horse having been cast with the diseased side uppermost
and the head turned to the light, the tumor is seized with the fingers,
the forceps, or hook, and drawn gently outward. The chain of the
_ecraseur_ may be passed over it and slowly tightened upon the pedicle
until it is cut through. This will usually obviate any laceration of the
turbinated bones and consequent bleeding. In case of serious hæmorrhage
check by cold water, ice, the actual cautery, or by plugging. Polypi
with a broad base may be removed with a prob-pointed knife, curved on
the flat, and furnished with a long handle. The mass is seized with a
vulsella and detachment made by passing the knife with the concave side
toward the tumor. In cases where the tumor cannot be seen or reached
some have resorted to slitting up the outer wall of the nostril as far
as the angle of union of the nasal and maxillary bones, care being taken
to make the incision outside the upper end of the cartilage of the ala
nasi. If too high to be satisfactorily reached in this way the nasal or
frontal bone may be trephined over the body of the tumor as indicated by
the flatness on percussion, and the operation performed through the
opening thus made.
II. =Actinomycosis.= Though much more common in cattle than horses, yet
the occasional occurrence of this in the face of the solipede must not
pass unnoticed.
III. =Sarcoma= and =Carcinoma.= These are found growing from the
periosteum, or even starting in the cancellated tissue and projecting
into the nose, where they give rise to symptoms like those of fibrous
polypi. Being much softer in texture and more liable to ulceration and
degeneration they are likely to cause a much more offensive discharge.
There is also more tendency to the implication of the submaxillary
lymphatic glands. The only treatment is surgical and recurrence is
always to be feared. (See Diseases of the Orbit.)
IV. =Fatty Tumors= of the nose are described by Röll and Gurlt as
existing on the septum and in the sinuses. Being simple, they can be
removed with great confidence as to nonrecurrence.
V. =Osseous Tumors of the Nasal walls.= These are described by Röll as
osteophytes in the maxillary sinus in chronic catarrh, and by Gamgee as
osteomata attached to the outer wall of the nasal chamber, which had to
be detached by saw and bone forceps. I have found these latter of a soft
porous structure easily detached by the knife, and in other cases dense
and requiring, chisel, saw and forceps. In one instance the tumor grew
from a dense hypertrophy of the maxillary bone which could not be
entirely removed because the molar alveoli were implicated.
VI. =Cysts= named by Röll and others as present in the mucosa of the
ethmoid cells in solipedes often contain larva of the strongylus
armatus.
VII. =Angioma= may be but an exaggerated development of the abundant
venous plexus and erectile tissue on the surface of the turbinated
bones. There appears to be at other times an actual increase of the
vascular tissue. As might be expected it has no abrupt margin, but
gradually shades off into the healthy tissue. The prominent centre has a
bluish red or brownish hue. It obstructs breathing, is apt to bleed
under violent exertions in draught, or in contested races, and readily
ulcerates with a bloody discharge. If it subsides and heals, it is
followed by a whitish puckering like the so-called _cicatrix_ of
glanders.