THE NASAL FOSSAE. 823 



skull, through the foramina in the cribriform plate of the ethmoid bone, and the 

 foramen caecum. 



The lymphatics can be injected from the subdural and subarachnoid spaces, 

 and form a plexus in the superficial portion of the mucous membrane. The 

 lymph is drained partly into one or two glands which lie near the great cornu of 

 the hyoid bone and partly into a gland situated in front of the axis. 



The nerves are : the olfactory, the nasal branch of the ophthalmic, filaments 

 from the anterior dental branch of the superior maxillary, the Vidian, the naso- 

 palatine, descending anterior palatine, and nasal branches of Meckel's ganglion. 



The olfactory, the special nerve of the sense of smell, is distributed to the 

 olfactory region, already referred to (page 820). 



The nasal branch of the ophthalmic distributes filaments to the fore part of the 

 septum and outer wall of the nasal fossae. 



Filaments from the anterior dental branch of the superior maxillary supply the 

 inferior meatus and inferior turbinated bone. 



The Vidian nerve supplies the upper and back part of the septum and superior 

 spongy bone, and the upper anterior nasal branches from the spheno-palatine 

 ganglion have a similar distribution. 



The naso-palatine nerve supplies the middle of the septum. 



The larger or anterior palatine nerve supplies the lower nasal branches to the 

 .middle and lower spongy bones. 



Surgical Anatomy. Instances of congenital deformity of the nose are occasionally met 

 with, such as complete absence of the nose, an aperture only being present ; or perfect develop- 

 ment on one side, and suppression or malformation on the other ; or there may be imperfect 

 apposition of the nasal bones, so that the nose presents a median cleft or furrow. Deformities 

 which have been acquired are much more common, such as flattening of the nose, the result of 

 syphilitic necrosis, or imperfect development of the nasal bones in cases of congenital syphilis, or 

 a lateral deviation of the nose may result from fracture. 



The skin over the alae and tip of the nose is thick and closely adherent to subjacent parts. 

 Inflammation of this part is therefore very painful, on account of the tension. It is largely sup- 

 plied with blood, and, the circulation here being terminal, vascular engorgement is liable to occur, 

 especially in women at the menopause and in both sexes from disorders of digestion, exposure to 

 cold, etc. The skin of the nose also contains a large number of sebaceous follicles, and these, as 

 the result of intemperance, are apt to become affected and the nose reddened, congested, and 

 irregularly swollen. To this the term ' ' grog-blossom ' ' is popularly applied. In some of these cases 

 there is enormous hypertrophy of the skin and subcutaneous tissues, producing pendulous masses, 

 termed lipomata nasi. Epithelioma and rodent ulcer may attack the nose, the latter being the 

 more common of the two. Lupus and syphilitic ulceration frequently attack the nose, and may 

 destroy the whole of the cartilaginous portion. In fact, lupus vulgaris begins more frequently on 

 the ala of the nose than in any other situation. 



Cases of congenital occlusion of one or both nostrils, or adhesion between the ala and septum 

 may occur, and may require immediate operation, since the obstruction much interferes with suck- 

 ing. Bony closure of the posterior nares may also occur. 



To examine the nasal cavities, the head should be thrown back and the nose drawn upward, 

 the parts being dilated by some form of speculum. It can also be examined with the little finger 

 or a probe, and in this way foreign bodies detected. A still more extensive examination can be 

 made by Rouge's operation, which was introduced for the cure of ozasna by the removal of any 

 dead bone which may be present in this disease. The whole framework of the nose is lifted up 

 by an incision made inside the mouth, through the junction of the upper lip with the bone ; the 

 septum nasi and the lateral cartilages are divided with strong scissors till the anterior nares are 

 completely exposed. The posterior nares can be explored by reflected light from the mouth, by 

 which the posterior nares can be illuminated. The examination is very difficult to carry out, 

 and, as a rule, sufficient information regarding the presence of foreign bodies or tumors in the 

 nasopharynx can be obtained by the introduction of the finger behind the soft palate through 

 the mouth. The septum of the nose may be displaced or deviate from the middle line : this 

 may be the result of an injury or from some congenital defect in its development ; in the latter 

 case the deviation usually occurs along the line of union of the vomer and mesethmoid, and rarely 

 occurs before the seventh year. Sometimes the deviation may be so great that the septum may 

 come in contact with the outer wall of the nasal fossae, and may even become adherent to it, 

 thus producing complete obstruction. Perforation of the septum is not an uncommon affection 

 and may arise from several causes : syphilitic or tubercular ulceration, blood-tumor or abscess of 

 the septum, and especially in workmen exposed to the vapor of bichromate of potash, from the 

 irritating and corrosive action of fumes. When small, the perforation may cause a peculiar 

 whistling sound during respiration. When large, it may lead to the falling in of tho bridge of 

 the nose. 



