Injuries To The Nose

The bones and cartilages may be fractured or dislocated. This may involve either the outside structures or those forming the septum, and often both. The displacement depends on the character and direction of the injury. It is either a displacement to one side, or the nose is crushed, producing a flattening of the bridge. If the displacement is lateral, whether by a dislocation or fracture, there is liable to be a deviation of the septum, because the bony and cartilaginous septum is connected with the bones and is apt to be carried with them to the side. If the displacement is inward, not only are the nasal bones depressed, but the septum beneath may be either bent or fractured. The pushing of the septum toward the floor causes it to buckle and bend or even break at the junction of the triangular cartilage with the perpendicular plate of the ethmoid and the vomer. In treating these fractures, the most efficient method is to grasp the septum with the flat blades of an Adams forceps (after cocainization) and lift the bones up or to one side as needed. In cases where it is not desired to use the forceps, the writer grasps the nose with a wet towel, makes traction to loosen the fragments, and then pushes them over into place. The triangular cartilage is frequently injured; with the displacement or loosening of the upper lateral cartilages a great amount of displacement may be caused, so that the nose instead of forming a straight line is bent to one side from the ends of the bones down to the tip. Injuries to the septum in childhood are probably the cause of a large number of the cases of deviation of the septum, spurs, etc., seen later in life.

Fig. 112.   Bony and cartilaginous framework of nose, front aspect. (Piersol).

Fig. 112. - Bony and cartilaginous framework of nose, front aspect. (Piersol).

Fig. 113.   Fracture of the nose with deflection of the nasal bone laterally.

Fig. 113. - Fracture of the nose with deflection of the nasal bone laterally.

In fractures the mucous membrane is often torn, thus allowing air to enter the tissues at the site of fracture, producing emphysema. If such a patient blows the nose violently, the air may be forced under the skin of the face, around the eyes and up the forehead.

Anterior Nares

The nostrils or anterior nares in the white race are an elongated oval in shape and run in an anteroposterior direction, being separated from each other by the columna. They lie in a direction parallel with the floor of the nose, so that to examine the nasal fossae with a speculum the instrument is first introduced from below, then tilting the tip of the nose upward, the speculum is directed backward. To see the floor of the nose, it is necessary to raise the outer end of the speculum still higher, because the floor is below the bony edge. From the outer edge of the nostril the nasal cavities go upward and backward for a distance of . 5 to 1 cm. This part, called the vestibule, is covered by skin, not mucous membrane. It bears stiff hairs - vibrissae. Inflammation of these hair-follicles and associated glands produces exceedingly painful pustules. It is here likewise that dried mucus collects and forms scabs, which stick to the hairs and are hard to remove. The attempt to remove them probably is the cause of infection and inflammation around the roots of the hairs. The vestibule leads to the ridge of bone or crest, which is directly posterior to the side of the nasal spine. This ridge of bone is on a higher level than the floor of the nose, and in order to view the latter the nostrils must be raised, by means of the speculum, above it (Fig. 115).

Fig. 114   Fracture of the nose showing depression of the nasal bone.

Fig. 114 - Fracture of the nose showing depression of the nasal bone.