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THE ANATOMY OF THE NOSE





Category: Respiratory Diseases

The nose is divided by a middle partition
(septum) into two cavities (nasal chambers or fossae) each being a
wedge-shaped cavity, distinct by itself and extending from the nostril or
anterior nares in front to the posterior openings behind and from the base
of the skull to the hard palate below. Where the posterior opening or
nares ends is called the nose-pharynx, The pharynx joins there with the
cavities and hence called nose-pharynx. The partition (septum) is thin,
one-tenth to one-eighth of an inch in thickness and is composed in front
of cartilage (gristle) and behind of bone. In its normal state this
partition (septum) should be perfectly straight, thin and in the middle
line, The cartilaginous (gristle) portion is seldom found in this
condition as, owing to its prominent location and frequent exposure to
injury, blows and falling on the nose, the partition (septum) is often
bent or turned to one side or the other so far in some cases as to close
the nostril. The posterior part is composed of bone, and being well
protected, is seldom found out of position or displaced, even when the
cartilaginous portion is often badly deformed, The floor of the nose is
formed by the upper jaw bone (maxillary) and the palate bone. The outer
wall of the nose or nose cavity is the most complicated, for it presents
three prominences, the turbinated bones, which extend from before
backwards and partially divide the nose cavity into incomplete spaces
called meatus passages. The turbinated bones are three in number, the
inferior, middle and superior. They vary in size and shape, and owing to
the relations they hear to the surrounding parts, and to the influence
they exert on the general condition of the nose and throat, are of great
importance. The inferior or lower turbinate bone is the largest and in a
way is the only independent bone. The middle and superior are small. They
are all concave in shape and extend from before backwards, and beneath the
concave surface of each one of the corresponding passages or openings
(meatus) is formed. The inferior or lower (meatus) opening or passage is
that part of the nasal (nose) passage which lies beneath the inferior
turbinate bone and extends from the nostrils in front to the passage
behind the nose (post-nasal) (posterior nares) toward the pharynx. The
middle opening (meatus) lies above the inferior turbinate bone and below
the middle turbinate bone. The superior opening (meatus) is situated above
the middle turbinate bone.


The mucous membrane lining the nasal passages is similar to other mucous
membranes. It is here called the Schneiderian membrane after the name of a
German anatomist named Schneider. It is continuous through the ducts with
the mucous membrane of all the various accessory cavities of the nose. It
is quite thin, in the upper part over the superior turbinate bone and
partition (septum) while it is quite thick over the lower turbinate bone,
the floor of the nose cavity and the lower part of the partition. It is
well supplied with blood vessels, veins, and glands for producing the
necessary secretion.

The nose is an organ of breathing (respiration) and it warms and moistens
the air we breathe and arrests particles of dust in the air before they
enter the lungs. If the air we breathe is of an uneven temperature, or of
marked degree of dryness, or if it is saturated with impurities, it always
acts as a source of irritation to the mucous membrane of the upper
respiratory tract, like the larynx. By the time the air reaches the
pharynx, through the nose, it has become almost as warm as the blood, and
also is well saturated with moisture. The mucous membrane that lines the
nose cavity and especially that part over the lower turbinate bone,
secretes from sixteen to twenty ounces of fluid daily. This fluid cleanses
and lubricates the nose and moistens the air we breathe. Conditions may
arise which interfere with this natural secretion. This may be due to the
fact that some of the glands have shrunk or wasted (atrophied) and the
secretion has become thick. This collects in the nose, decomposes and
forms scabs and crusts in the nostrils. In this condition there will be
dropping of mucus into the throat. This condition is usually only a
collection of secretions from the nose,--which are too thick to flow
away,--collect in the space behind the nose, and when some have
accumulated, drop into the pharynx.


In order to be in good health it is necessary to breath through the nose,
and to do this there must be nothing in the nose or upper part of the
pharynx to interfere with the free circulation of the air through these
cavities. The cavities of the nose may be partly closed by polpi (tumors)
on the upper and middle turbinate bone, a spur on the (septum) partition,
deviation of the partition or enlarged turbinate bones, or adenoids in the
upper part of the pharynx. These troubles almost close up the nose
sometimes and the person is compelled to breathe through his mouth. He not
only looks foolish, talks thick, but is laying up for himself future
trouble. By correcting the trouble in the nose and removing the adenoids
in the upper part of the pharynx the patient can breathe through the nasal
passages. If you take a tube you can pass it straight back through the
lower channel (meatus) into the pharynx. It will touch the upper back wall
of the pharynx. If the tube has a downward bend you can see it behind the
soft palate and by attaching a string to that end you can draw it back out
through the nostrils. In that way we plug the posterior openings (nares).
The upper part of the pharynx reaches higher up behind than a line drawn
horizontally above the tip of the nose to the pharynx. It reaches forward
above the soft palate on its front surface. Its front surface is almost
directly on a vertical line with tonsil, above the soft palate. On its
upper part and on the side near the nose cavity is the opening of the
eustachian tube.

The name naso-pharynx means the junction of the nose and pharynx.
Sometimes the upper posterior wall of the pharynx, called the vault of the
pharynx, especially the part behind each eustachian tube, is filled almost
full with adenoids. These are overgrowths or thickenings of the glandular
tissue in the upper posterior wall of the pharynx (vault of the pharynx).

ADENOIDS. (Pharyngeal Tonsil, Lursehkas Tonsil, Adenoid Vegetation, Post-
nasal Growth.)--Adenoids are overgrowths or thickenings of the glandular
tissue in the vault (top) of the pharynx. They are on the upper posterior
wall of the pharynx, often filling the whole space, especially the part
behind the ear-tube--eustachian tube.

They are a soft pliable mass, well supplied with blood vessels, especially
in children. Some are firmer and these are the kind seen in adults. The
color varies from pale pink to dark red. The structure is similar to
enlarged tonsils.


Symptoms: Children breathe chiefly or wholly through the mouth. They are
apt to breathe noisily, especially when they eat and drink. They sleep
with their mouth open, breathe hard and snore. They have attacks of slight
suffocation sometimes, especially seen in young children. There may be
difficulty in nursing in infants; they sleep poorly, toss about in bed,
moan, talk, and night terrors are common. They may also sweat very much
during sleep. A constant hacking or barking cough is a common symptom and
this cough is often troublesome for some hours before going to bed.
Troubles with the larynx and pharynx are common and spasmodic laryngitis
appears to be often dependent upon adenoids. Bronchial asthma and sneezing
in paroxysms are sometimes connected with them. The chest becomes
deformed. The prolonged mouth-breathing imparts to adenoid patients a
characteristic look in the face. The lower jaw is dropped and the lips are
kept constantly apart. In many cases the upper lip is short, showing some
part of the upper teeth. The dropping of the jaw draws upon the soft parts
and tends to obliterate the natural folds of the face about the nose,
lips, and cheeks. The face has an elongated appearance and the expression
is vacant, listless, or even stupid. The nose is narrow and pinched, from
long continued inaction of the wings of the nose (alae nasi). The root of
the nose may be flat and broad. When the disease sets in during early
childhood, the palate may become high arched. If the disease continues
beyond second teething, the arch of the palate becomes higher and the top
of the arch more pointed. The upper jaw elongates and this often causes
the front teeth to project far beyond the corresponding teeth in the lower
jaw. The high arched palate is often observed to be associated with a
deflected partition (septum) in the nose.

The speech is affected in a characteristic way; it acquires a dead
character. There is inability to pronounce the nasal consonant sounds; m,
n, and ng and the l, r, and th sounds are changed. Some backwardness in
learning to articulate is often noticed.

Deafness is frequently present, varying in degree, transient and
persistent. Attacks of earache are common and also running of the ears.
The ear troubles often arise from the extension of catarrh from the
nose-pharynx through the eustachian tubes to the middle ear. Sometimes the
adenoids block the entrance to the tubes. The ventilation of the middle
ear may be impeded. Dr. Ball, of London, England, says: "Ear troubles in
children are undoubtedly, in the vast majority of cases, dependent upon
the presence of adenoid vegetation" (growths).

Children with adenoids are very liable to colds in the head, which
aggravate all the symptoms, and in the slighter forms of the disease the
symptoms may hardly be noticeable, except when the child is suffering from
a cold.


Chronic catarrh is often caused by adenoids. A chronic pus discharge often
develops, especially in children. There is often a half-pus discharge
trickling over the posterior wall of the pharynx from the nose-pharynx.
And yet some children with adenoids never have any discharge from the
nose. There may be more or less dribbling of saliva from the mouth,
especially in young children, and this is usually worse during sleep.
Headache is not uncommon when these growths persist into adult life: they
continue to give rise to most of the symptoms just described, although
these symptoms may be less marked because of the relatively larger size of
the nose-pharynx. The older patients seek relief, usually, from nasal
catarrh symptoms. They complain of a dry throat on waking and they hawk
and cough, In order to clear the sticky secretion from the throat. The
adenoids have often undergone a considerable amount of shrinking, but they
frequently give rise to a troublesome inflammation of the nose and
pharynx. Rounded or irregular red elevations will often be seen on the
posterior wall of the pharynx, outgrowths of adenoid tissue in this
region. Similar elevations are sometimes seen on the posterior pillars of
the fauces. The tonsils are often enlarged. A good deal of thick discharge
will sometimes be seen in the posterior wall of the pharynx proceeding
from the nose-pharynx.

Although adenoids, like the normal tonsil, usually tend to diminish and
disappear with the approach of youth, they constitute during childhood a
constant source of danger and trouble and not infrequently inflict
permanent mischief. Also children afflicted with adenoids are less able to
cope with diphtheria, scarlet fever, measles, whooping-cough, etc.

Deafness, mouth-breathing habit, and imperfect resonance of the voice, as
well as the characteristic expression of the face, will often remain as
permanent effects of the impairment of function due to these growths in
childhood, even though they have more or less completely disappeared. The
collapsed state of the wings of the nose, and wasted condition of their
muscles, resulting from long disease, often contributes to the
perpetuation of the mouth-breathing habit. On the other hand the rapid
improvement, after a timely removal of the growths, is usually very
striking.

Treatment: The only thing to do is to remove them soon, no matter how
young the patient may be. An anaesthetic is usually given to children. The
operation does not take long and the patient soon recovers from its
effects. The result of an operation, especially in young children, is
usually very satisfactory. Breathing through the nose is re-established,
the face expression is changed for the better. The symptoms as before
described disappear to a great extent.





Next: COLDS. (Coryza. Acute Nasal Catarrh. Acute Rhinitis)




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