An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:: 1899

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

1163/1336 (page 1121)

$entirely upon the brain-complication. The secondary complications which may follow these injuries are deformities of the nose, injury to the lachrymal apparatus, impairment of the sense of smell (either from occlusion of the nasal passages or injury to the olfactory nerve), and lack of resonance in the voice, owing to the contraction of the nasal passages. Treatment.—In all cases of fracture of the nose the replacement of the fragments should be effected as speedily as possible, before swelling of the parts has supervened to prevent it; for when the swelling is extensive it is frequently necessary to wait until it subsides before the fragments can be replaced. This can usually be delayed for three or four days with perfect safety, although if the case is seen early, much of the swelling can be prevented by attention to antiseptic and antiphlogistic measures. In case the fracture is a compound one, we should attend carefully to the wound of the skin (as in case of lacerated wounds of the nose) in order to prevent, as far as possible, disfigurement from resulting scars. Laceration of the mucous membrane should also receive attention and be rendered, as far as possible, aseptic. In simple fractures the reduction is best accomplished with a smooth sound, placed in the interior of the nostril to raise the depressed fragments, and their coaptation is facilitated with the fingers on the outside of the nose. When no sound is at hand and the nasal passages are sufficiently large to admit the little finger, it can be very advantageously substituted. In some cases the fragments are best and most easily adjusted by means of a pair of smooth-blade forceps, one blade placed in the nostril and the other outside, according to the plan of Weber, care being exercised not to use too much pressure; and to avoid lacerating the tissue the blades can be covered with rubber or adhesive plaster. For this purpose Molliere uses forceps with ivory blades. When the septum has at the same time become fractured or dislocated, it also should be put in place. JT iL When the fragments have been replaced, they iiilk^*^' must be held with some form of retentive appa- Fig. 641.—The author's metallic form. Fig. 642.—Metallic form and adhesive plaster as applied. ratus. If the skin is unbroken, a piece of rubber adhesive plaster, cut of the shape to completely cover the nose, has been found by the author to be one of the most important aids in rendering the exterior contour smooth and symmetrical. This is to be covered with a metallic form (Fig. 641), made$