THE ANATOMY OF THE NOSE

Categories: 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 nos -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.