9 8 



APPLIED ANATOMY. 



times form a distinct ridge of bone running upward and backward. If the spur is 

 short in extent, the farther posterior it is situated, the higher up it is on the septum. 

 If marked, it is often accompanied by deviation of the septum and it may impinge 

 on the lower turbinated bone opposite to it. These spurs are usually removed by 

 sawing. A narrow-bladed saw is introduced with its back on the floor of the nose 

 and the spur removed by sawing upward (Fig. 118). 



Epistaxis or bleeding from the nose is said to occur in a large percentage of 

 the cases from the septal branch of the sphenopalatine artery. This comes from the 

 internal maxillary artery through the sphenopalatine foramen and passes downward 

 and forward as the nasopalatine or artery of the septum. It anastomoses below with 

 the anterior palatine branch of the descending palatine artery as it comes up from 

 the roof of the mouth through the foramen of Stenson (incisor foramen). It also 

 anastomoses with the inferior artery of the septum, a branch of the superior coronary. 

 The bleeding point is to be sought for low down on the anterior portion of the 

 cartilaginous septum near the anterior nares. Hemorrhage can be stopped by 

 packing only the anterior or both the anterior and posterior nares. 



Perpendicular plate 

 of ethmoid 



Triangular cartilage 



Vomer 



FIG. 117. Septum of the nose. 



The arteries supplying the nasal cavities (Fig. 119) come from three directions : 

 superior the anterior and posterior ethmoidal, supplying the ethmoidal cells, the 

 upper portion of the septum, the roof, and the outer wall anteriorly; inferior the septal 

 branch of the superior coronary artery and a branch of the descending palatine artery 

 coming up through the incisor foramen; posterior the sphenopalatine, giving its 

 nasopalatine branch to the septum and also supplying branches to the ethmoidal 

 cells, frontal and maxillary sinuses, and outer wall of nose, the Vidian and pterygo- 

 palatine going to the posterior portion of the roof, and the descending palatine giving 

 branches to the posterior portion of the inferior meatus and posterior end of the 

 inferior turbinated bone. 



The veins, like the arteries, are in three sets: the superior are formed by the 

 anterior and posterior ethmoidal and some smaller veins passing upward through the 

 foramen in the cribriform plate, or foramen ccecum, to the longitudinal sinus; the 

 inferior communicate with the facial veins through the anterior nares; the posterior 

 drain upward and backward through the sphenopalatine foramen into the pterygoid 

 plexus. 



The lymphatics drain either anteriorly on the face or posteriorly through the 

 deep lymphatics of the neck. Therefore, acrid secretions causing ulcerations of the 

 anterior nares are liable to be accompanied by swelling of the submaxillary lymphatic 



