PRACTICAL CONSIDERATIONS: THE EXTERNAL NOSE. 1407 



fatty tissue is very meagre. The sebaceous glands, on the other hand, are well 

 developed and open in many instances in conjunction with the follicles of the delicate 

 hairs that cover all parts of the surface. On the alae the closely placed glands are of 

 exceptional size and open by ducts readily seen as minute depressions. 



Vessels. In order to compensate for the exposed position, the external nose 

 is generously supplied with arteries^ derived chiefly from the facial and ophthalmic, 

 which are united by numerous anastomoses with each other as well as with branches 

 from the infraorbital. The veins are all tributary to the angular vein, which begins 

 at the inner canthus and descends along the side of the nose to the facial trunk, 

 receiving in its course the dorsal, lateral, and alar branches. The angular vein 

 communicates with the ophthalmic and the veins of the nasal fossa. 



The lymphatics are arranged in three sets (Kuttner). The first, beginning at 

 the root of the nose, passes above the upper eye-lid and along the supraorbital ridge 

 to the parotid nodes. The second group, formed by the superficial and deep lym- 

 phatics at the nasal root, skirts the lower margin of the orbit and ends in the lower 

 parotid nodes. The third and most important set includes from 6 to 10 trunks that 

 follow the blood-vessels and end in the submaxillary nodes. 



The nerves supplying the outer nose include the motor branches of the facial 

 to the muscles and the sensory twigs from the trifacial to the skin, distributed by the 

 infratrochlear and nasal branches of the ophthalmic and by the infraorbital of the 

 superior maxillary. 



PRACTICAL CONSIDERATIONS : THE EXTERNAL NOSE. 



The Nose may be congenitally absent, or bifid, or imperfect, as from absence 

 of the septum or of one nostril, or very rarely of both nostrils. As to its external 

 aspect it may be of various types, e.g. : Grecian, when the dorsum is on a practi- 

 cally continuous straight line with the forehead, with no marked naso-frontal groove ; 

 aquiline, with the dorsum slightly arched ; rounded, with the arch much more 

 pronounced; foetal "pug" with the bridge depressed and the nostrils directed 

 somewhat forward. 



The foetal type is simulated in the new born by the subjects of inherited 

 syphilis in whom the bridge of the nose is often much depressed as a result 

 either of (a) imperfect development following the severe specific coryza that 

 affects the nasal mucosa and, through the close apposition of the latter to the 

 periosteum of the fragile nasal bones, interferes with their nutrition ; or () by 

 actual caries or necrosis of those bones or of the septum favored by the same 

 conditions. In acquired syphilis the similar nasal deformity is practically always 

 the result of the destruction of the septum, or, less frequently, of the nasal bones, by 

 late (tertiary) lesions. 



As a consequence of faulty development in the anterior mid-portion of the 

 frontal bone the membranes of the brain may protrude, forming a meningocele, 

 which is more common at the naso-frontal junction than elsewhere. Occasionally 

 the defect permitting the protrusion exists in the cribriform plate of the ethmoid, 

 and the meningocele occupies the nasal fossa, having under these circumstances 

 been mistaken for a nasal polyp and removed, death resulting from subsequent septic 

 meningitis. 



The cosmetic importance of the nose is so great, the diseases producing 

 deformity so frequent, and the susceptibility of the organ to injury so marked, that 

 much ingenuity has been expended upon devices to restore it when lost, or to 

 improve its appearance. In the Tagliacotian operation a cutaneous flap is taken 

 from the arm which is held close to the nose by a complicated dressing until the flap 

 is firmly united in its new position, when its pedicle is detached from the arm. The 

 Indian method is more particularly anatomical, since the flap taken from the fore- 

 head is so fashioned that it receives intact the blood from the frontal branch of the 

 ophthalmic artery from the internal carotid, the ophthalmic receiving at the origin 

 of the frontal an important anastomosis from the angular branch of the facial artery, 

 which is given off from the external carotid artery. For partial deformities flaps 

 may be taken from the sides according to the size and situation of the deficiency. 



