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Comparable flap operations incorporating curettage and osteoplasties were performed in 17 patients on opposite sides of the same jaw on separate occasions. For one side a cover of phenoxymethyl penicillin 250 mg q.d.s. for 5 days commencing at the time of operation was given and for the other side a placebo was used. Healing was more advanced at 1 week after operation and there was less post-operative discomfort during the first week when the penicillin cover was used. There was a tendency towards less facial swelling when penicillin was administered but the difference was not significant.

SUMMARY Based on experience of 16 horses showing spontaneous epistaxis, a description is given of a previously unrecognised disease. An encapsulated haematoma originates in or near the ethmoid labyrinth and gradually expands, first into the nasal cavity and then into the nasopharynx. The principal clinical sign is a slight, persistent, unilateral nasal discharge of blood or bloodstained mucus. Other signs can include respiratory obstruction, coughing, choking and facial swelling. Diagnosis may be confirmed by rhinoscopy, radiography and trephining the paranasal sinuses. Surgical resection of the haematoma and the affected ethmoid labyrinth has been carried out in 13 horses but the lesion has recurred in five. Histologically, the capsule of the haematoma is composed of respiratory epithelium and fibrous tissue, and the stroma contains blood, macrophages, multinucleate giant cells and some fibrous tissue. The cause of this disease is not yet understood. RESUME L'etude de seize cas de chevaux montrant un epistaxis spontane, donne l'occasion de decrire une affection jusqu'alors inconnue. Un hematome encapsule prend naissance soit dans, soit pres du labyrinthe ethmoidien. Progressivement cet hematome se developpe, d'abord dans la cavite nasale puis dans le naso pharynx. Le signe clinique principal est un leger ecoulement nasal unilateral et persistant compose de sang ou de mucus mele de sang. Parmi les autres signes de cette affection, on peut rencontrer ceux d'une obstruction respiratoire, ceux d'une pseudo-obstruction oesophagienne, parfois de l'oedeme facial, et parfois de la toux. Le diagnostic peut etre confirme par rhinoscopie, par radiographie, et en trepanant les sinus paranaseaux. La resection chirurgicale de l'hematome et du labyrinthe ethmoidien atteint a ete effectuee, mais, dans deux cas sur cinq, on a observe une recidive. D'un point de vue histologique, on a constate que la capsule de l'hematome est formee d'epithelium respiratoire et de tissu fibreux, le stroma renferme du sang, des macrophages, des cellules geantes multinucleees et du tissu fibreux. La cause de cette maladie n'est pas encore connue. ZUSAMMENFASSUNG Aufgrund von Erfahrungen bei 16 Pferden mit spontaner Epistaxis wird eine bisher nicht erkannte Krankheit beschrieben. Ein abgekapseltes Haematom entsteht im oder nahe am Ethmoid und breitet sich zuerst in die Nasenhohle spater dann in den Nasopharynx aus. Das hervorstechende klinische Zeichen ist ein leichter, persistierender, unilateraler, blutiger oder blutig-mucoser Nasenausfluss. Daneben konnen etwa Zeichen einer respiratorischen Obstruktion, Husten, Erstickungsanfalle und Gesichtsanschwellungen beobachtet werden. Die Diagnose kann bestatigt werden durch Rhinoskopie, Rontgen und Trepanation der paranasalen Hohlen. Die Resektion des Haematoms und des affizierten ethmoidalen Labyrinths wurde durchgefuhrt, aber bei zwei Funftel der Patienten stellte sich ein Recidiv ein. Histologisch besteht die Haematomkapsel aus respiratorischem Epithel und fibrosem Gewebe und das Stroma enthalt Blut, Makrophagen, multinukleare Riesenzellen und etwas fibroses Gewebe. Die Ursache der Krankheit ist noch unbekannt.

Six cases of chronic masticator space infection associated with firm facial swelling and progressive trismus are described. Intraoral wound drainage and prolonged antibiotic therapy failed to control the resultant chronic cellulitis. Exposure and drainage of the masticator space and contiguous structures through a modified Blair preauricular and cervical incision was performed. The combination of multifocal drainage, limited debridement, and adjunctive antibiotic therapy controlled the inflammatory response and hastened rehabilitation.

A 72-year-old lady was admitted to hospital with an acute facial swelling which proved to be caused by the recurrence of an odontogenic keratocyst in a bone graft inserted 21 years previously. The possible reasons for recurrence are discussed, with emphasis placed on the type of epithelium involved. Different methods of treatment are reviewed.

Facial subcutaneous emphysema, which usually occurs during surgery that involves opening of the maxillary sinus, was experienced by a patient who was being prepared for a porcelain jacket crown. She experienced difficulty in breathing, pain, and facial swelling. A non-narcotic analgesic was prescribed and within five days the pain and swelling subsided.

Twenty-four hours after extraction of her mandibular second molar, the patient complained of pain and an inability to swallow. There was a slight facial swelling. Three days after the extraction procedure, the patient was admitted to the hospital for treatment. A diagnosis of subcutaneous emphysema was made. Dentists who use high-speed air-turbine instruments must be aware of the dangers of introduction of air into the subcutaneous tissues and of the possible sequelae.

SEVERAL cases of the syndrome of infantile cortical hyperostosis have been reported since Caffey and Silverman1first described this heretofore unknown disease of infants. Smyth, Potter and Silverman2were among the early workers to add to the rapidly growing number of cases. These were followed with reports by Whipple,3Dickson and his associates,4Shuman5and Gipson and Clark6and from the Children's Hospital, Washington, D. C.7The purpose of this report is to present 2 additional cases of this syndrome and to discuss some variable aspects of the disease. REPORT OF CASES Case1.—M. A. F., a 5 month old Italian infant, was admitted to the babies' wards of the New York Post-Graduate Hospital on Nov. 11, 1947 because of a facial swelling since 2 weeks of age. Family History.—The parents were living and in good health. There were no known familial

This case presents several unusual features. Of special interest is the simultaneous occurrence of congenital arteriovenous malformation and neurofibromas in the face and scalp. The massive facial swelling noted after acute trauma was far greater than that usually seen with blunt trauma, even in association with facial fractures.

R.M., a well-built adult of 28 years of age, was referred to the medical specialist on account of headaches and an asymmetrical facial swelling. With the exception of a fall on his face at the age of four years, he had had no previous illness prior to 1940, when he sustained a lacerated wound of the forehead and since when he has experienced frequent headaches of a mild and generalised nature. The asymmetry of his face and the swelling in the right zygomatic region has been present for as long as he can remember, but in the last six months he claims a noticeable increase in its size and that his size in hats has been increasing.

SALIVARY-gland swelling is an infrequent manifestation of "iodism" or iodide idiosyncrasy, occurring after therapy with inorganic, iodine compounds. Its appearance may suggest the possibility of mumps or stone in the salivary ducts and lead to embarrassing, tedious and sometimes costly investigations. The following cases are reported because salivary-gland swelling occurred as a sequel to intravenous urography with new organic iodide preparations, diatrizoate sodium (Hypaque) and sodium methylglucamine diacetylamino-triiodobenzoates (Renografin), and introduced the diagnostic possibilities of epidemic parotitis and salivary-duct calculus. Case Reports Case 1. M.E., a 68-year-old merchant, complained of right-sided facial swelling and tenderness. He had recently had a . . .