Excerpt from The American Journal of Surgery, 1905, Vol. 35
It is a matter of lively interest to humanity that the nose do its work well. This interest is so great that it is strange to find that attention to the pathology of the nose is to a great extent a matter of our own generation. In our older medical texts consideration of diseases of the nose covers not more than two or three pages. When many present day practitioners were undergraduate students perhaps one-half of a lecture was devoted to the same subject. But with the accumulation of special knowledge of the past decades growing out of the increase in clinical instruction, a special technique and a rapidly increasing literature has come into existence.
With the development of knowledge concerning the nose and its work came a realization that its prominence exposed it to injuries which became the source of other difficulties often not traced to their true source. Breaks, dislocations, and bruises, often looked upon at the time as negligible and of little moment, are later found to have caused blockages of the air passages which have interfered with normal breathing and with the drainage of the sinuses, and have caused serious nervous difficulties. Among the chief causes of these difficulties are deflection of the nasal septum. The development of surgical technique has made possible the correction of many of these difficulties with the aid of the knife.
It is the purpose of this study to put into a permanent form the result of many years of study of the causes and results of deviations of the nasal septum, together with a description of the operation for relief from the results of these deviations - the submucous resection of the nasal septum. Operations for these difficulties have been performed not more than twenty years. The operation is still classed as one of the most delicate and difficult of intranasal operations, (Phillips, Porter, Harmon Smith.) It therefore seems desirable to add to the information available the results of the writers clinic and private practice in dealing with several thousand cases.
In order to present more clearly the special study, we shall first consider briefly the normal nose, taking into account the pertinent features of its anatomy, physiology, and neurology.
The nose consists anatomically of two parts: the outer nose; and the nasal cavities contained in the skull. The lower segment is the part concerned in respiration. In the upper part the cavities support the membrane containing the nerves of smell. Posteriorly the nose is continuous with the cavity called the na o-pharynx, the two openings into which are called the choanae. The bony frame of the nose is a part of the skull, but the outer nose is supported by bone above only; the rest of its shape is kept by cartilaginous structures varying with race and individual. The anterior part of the nose is known as the ala or vestibule. This combination of bone and cartilage in the structure of the nose is of great importance, as we shall see in the study of fractures, dislocations, and deviations.
The roof of the nose, which is very narrow, is formed in front by the ethmoid and behind by the sphenoid. It is here, through the cribriform plate of the ethmoid bone, that some twenty non-medullated nerves pass to supply the sensory organs in the olfactory mucous membrane. This area, comprising the olfactory sense is very small, about 5 square centimeters in area, according to Watson, and consists of a small membrane lining the roof and sides of each nasal cavity.
The external wall of the nose is the most important of its areas from the surgical point of view. Continued malformations of the septum react on this outer wall with grave results. This area is formed by the lateral mass of the ethmoid, the inner surface of the superior maxilla, the vertical plate of the palate bone, and the internal pterygoid plate of the sphenoid. Это и многое другое вы найдете в книге The American Journal of Surgery, 1905, Vol. 35 (Classic Reprint)