NOSE. 



737 



which is in Sandifort's museum, and in which 

 the olfactory nerves and the nasal, lachrymal, 

 and ethmoid bones are all absent. 



Next to these are cases in which the nose 

 exists, but has not its naturally complex form. 

 Otto* describes two such in mature female 

 anencephalous children. The nose was in both 

 flat and broad ; it had but one nostril, and the 

 septum was absent. The inferior turbinated 

 bones were approximated posteriorly, so as in 

 one case to close the nasal cavity, and in the 

 other to reduce it to a very narrow aperture 

 opening into the pharynx. In one of these 

 children, also, the olfactory nerves were absent. 

 Sometimes a state like this exists on one side 

 only. Vrolikf mentions a child still living in 

 which the right half of the nose was fully deve- 

 loped, but on the left side there was a kind of 

 snout hanging from the root of the half nose, 

 perforated and giving passage to mucus and air. 

 Professor Broers cut off this appendage and the 

 aperture closed. 



The floor of the nasal fossse remaining in the 

 state which it naturally presents up to the third 

 month, constitutes cleft palate, a slight degree 

 of winch, since it produces no inconvenience, 

 is more common than is generally supposed. 

 When the membrane described as closing the 

 nostrils after about the ninth week is not 

 removed, the alresia nurium results. Several 

 cases fairly referable to this arrest of develope- 

 ment have been recorded.]; 



Defects of developement at a later period 

 are seen in the cases of absence of one or more 

 sinuses, of which also several cases have been 

 recorded. And with these, as errors of deve- 

 lopement produced perhaps by some accidental 

 pressure, may be enumerated the examples of 

 extreme obliquity or curvature of the septum, 

 in which the apex of the nose is turned com- 

 pletely to one side or even backwards towards 

 the cheek. Such are the cases for the remedy 

 of which Dieffenbach has lately applied with 

 success the subcutaneous division of the carti- 

 lages and the adjacent contracted tissues. 

 Another slight defect is that in which part of 

 the septum is deficient, or in which the bone is 

 perforated but is closed by membrane. Haller|| 

 describes a case in which the vomer was com- 

 pletely and widely perforated; but much more 

 commonly the defect is in the vertical plate of 

 the ethmoid bone. Very rarely there is an 

 aperture in the cartilaginous part of the septum. 

 The excellent anatomist Hildebrandt had a 

 defect of this kind -If 



A class of cases, which, though congenital, 

 cannot be certainly referred to arrest of deve- 

 lopement, are those of jissure of the nose. 

 Sometimes the nose alone is said to be divided 

 deeply in the median plane,** and this may 



* Monstrorum sex centommdescr.anat.N.vii.viii. 



t L. c. p. 260. 



t See Vrolik, 1. c. and Meckel, Handb. der pa- 

 thologischen Anatomie, Bd. i. p. 107. 



Casper's Wochenschrit't, Sept. 18, 1841. 



|| Elcmenta Physiologic, v. 137. 



IT Hildebrandt's Anatomie, by E. H. Weber, iv. 

 107. 



*' Isidore St. Hilaire, Traite des Anomalies, t. i. 

 p. 603. 



VOL. III. 



represent the foetal state in which the frontal 

 processes have not united, or in which the 

 septum is not yet formed. But the cases are 

 more numerous in which the fissure exists on 

 one or both sides of the face. In some it 

 extends from the angle of the mouth, through 

 one or both alae of the nose, to the internal or 

 external angle of the eye, laying into one the 

 cavities of the mouth, nose, and one or both 

 orbits. Tour sucli cases, differing but little 

 from each other, are recorded by \ A rolik. He 

 possesses also an example in which, in a much 

 less degree of the same defect, there is only a 

 fissure of the skin from the mouth to the eye 

 by the side of the right ala nasi ; and another, 

 in which a deeper fissure extends in the same 

 direction on both sides. These cases, how- 

 ever, like those of hare-lip, cannot be regarded 

 as mere arrests of developement : there is no 

 period in which the foetus is known to present 

 these as normal conditions. 



A very remarkable congenital defect in which 

 the nose is concerned, is that of which the 

 subjects have been called Cyclopian or Cyclo- 

 ceplialian monsters. It has been admirably illus- 

 trated in a special memoir by Dr. Vrolik,* who 

 points out five varieties of it. In the first, the 

 eyes are absent or not externally visible, and 

 the nose is either absent altogether or replaced 

 by a kind of proboscis or snout-shaped member, 

 consisting of little more than skin, and attached 

 above the orbit. In the second there is a single 

 orbit in the middle of the forehead which con- 

 tains a single eye-ball, and above which there 

 is sometimes a proboscis representing the nose. 

 In the third, the eye appears externally to be 

 single, but is internally double; and with this 

 again the nose may exist in the form of a pro- 

 boscis. In the fourth, the two eye-balls are 

 separated, but they lie in one orbit in contact, 

 or with only a narrow partition between them, 

 and above them there is a proboscis which, as 

 in the other cases, may be curved either 

 upwards or downwards. In the fifth, the pro- 

 boscis, approaching more nearly to the form of 

 a natural nose, has an osseous nucleus, and is 

 directed downwards; and the eye, above which 

 it is placed, is either double or single. In this 

 series, therefore, there is a regular gradation 

 from the natural to the most unnatural condi- 

 tion, in regard to both the nose and the eyes. 

 For the eyes, there is in some no eye at all; in 

 some a single eye-ball placed in the middle 

 line; in some again an eye-ball, which appears 

 single, contains parts of two ; and in some two 

 eye-balls lie close together in a single median 

 orbit. For the nose, it is in some altogether 

 absent; in some it exists in the form of a snout 

 which is little more than a prolongation of skin ; 

 in others it has a more or less well-formed 

 osseous nucleus; in some it is curled upwards 

 and backwards, in others directed obliquely 

 downwards : and among all these there are 

 numerous gradations of deformity. Now, any 

 of these conditions of the nose may co-exist 

 with any of those of the eye : there is no regular 



* Over den aard en oorsprong dcr Cyclopie, in 

 the Transactions of t lie Netherlands Institute, Am- 

 sterdam, 1836, and in his Haudboek, I), ii. p. 14. 



3 B 



