THE NOSE. 



97 



FIG. 115. Lateral view of the interior of the nose. 



inferior turbinated bone. Still higher is the middle meatus and the anterior end of the 

 middle turbinated bone. The superior turbinated bone is not visible from the front, 

 being in the upper posterior corner and hidden from sight by the middle turbinated. 

 Sometimes in the upper portion of 

 the nose, beneath the outer surface 

 of the anterior extremity of the mid- 

 dle turbinated bone, is seen a small 

 cleft, the hiatus semilunaris, leading 

 through the infundibulum into the 

 frontal sinus. If the inferior turbi- 

 nated has been shrunk with cocaine, 

 and if the inferior meatus is roomy, 

 one can see the posterior wall of the 

 pharynx. This can be seen moving 

 if the patient swallows, pronounces 

 the letter "k," etc., (Fig. 116). 



Septum. The nasal fossae are 

 separated from each other by the sep- 

 tum. This septum is formed (see 

 Fig. 117) by the triangular cartilage 

 in front, forming the cartilaginous sep- 

 tum, and the perpendicular plate of 

 the ethmoid and vomer behind, form- 

 ing the bony septum. The posterior 

 edge of the septum is formed solely 

 by the edge of the vomer ; it can readily be seen with the rhinoscopic mirror. The 

 affections of the septum are haematoma, ulcer and abscess, deviation to one side, 

 spurs or outgrowths, and it may be the site of nasal hemorrhages. H&matomas affect 



the cartilage of the septum and resemble 

 those of the ear. They are usually due 

 to traumatism and may become infected, 

 forming a pus-like detritus or abscess. 

 They can readily be recognized as a 

 fluctuating swelling on the septum, one 

 or both sides being affected. 



Deviations of the septum are bend- 

 ings toward one side, and cause serious 

 obstruction to breathing. They are prob- 

 ably traumatic in origin and involve the 

 cartilaginous portion. In operating for 

 their correction, incisions are made 

 through the cartilage and the projecting 

 part pushed toward the median line. In 

 some operations care is taken not to cut 

 through the mucous membrane on both 

 sides, as well as through the cartilage. 

 This is done to avoid the formation of 

 a permanent perforation of the septum, 

 the presence of which may cause a very 

 objectionable whistling sound when the 

 patient breathes. As the mucous mem- 

 brane covering the cartilage is thin, great 



rio. 116. Examining the anterior nares. Middle .... .... r-\ 



and inferior turbinates exposed to view. car is necessary in dividing the cartilage 



to avoid wounding the side which it is de- 

 sired to leave intact. The triangular cartilage is thin at its centre and thick at its edges. 

 Spurs are usually outgrowths of bone or cartilage occurring in the line of 

 juncture of the cartilage and vomer. On the floor of the nose the nasal crest may 

 project quite perceptibly to one side; a cartilaginous projection may likewise occupy 

 this site. As these spurs are found on the anterior edge of the vomer, they some- 

 1 



