NIORBID ANATOMY 00 THE NOSE.
Congenital defects.—The extreme of thece found when the normal state of the very ea fcetus continues and the nose is nearly abse Such a case is described by Soemmering. 1 child was born at the full term : the brain malformed, and there were no olfactory nerv In place of nasal bones there was but one lens-shaped bone, and the etlimoid bo little developed : the eyes were close t but the orbits had not coalesced. A example is mentioned by Roederer, in whi child with malformed ears had in place of nose a scarcely perceptible elevation, no nostrils, and for nasal fossm a blind pouch formed by mucous membrane. Vrolik,t by whom these cases are quoted, describes another in a pig -which is in Sandifort's museum, and in which the olfactory nerves and the nasal, lachrymal, and ethmoid bones are all absent.
Next to these are cases in which the nose exists, but has not its naturally complex form. Otto* describes two such in mature female anencephalous children. The nose was in both flat and broad ; it had but one nostril, and the septum was absent. The inferior turbinated bones were approximated posteriorly, so as in one case to close the nasal cavity, and in the other to reduce it to a very narrow aperture opening into the pharynx. In one of these children, also, the olfactory nerves were absent. Sometimes a state like this exists on one side only. Vrolikt mentions a child still living in which the right half of the nose was fully deve loped, but on the left side there was a kind of snout hanging frorn the root of.the half nose, perforated and giving passage to mucus and air. Professor Broers cut off this appendage and the aperture closed.
The floor of the nasal fossEe remaining in the state which it naturally presents up to the third month, constitutes cleft palate, a slight degree of which, since it produces no inconvenience, is more common than is generally supposed. When the membrane described as closing the nostrils after about the ninth week is not removed, the atresia narium results. Several cases fairly referable to this arrest of develope ment have been recordedl Defects of developernent at a later period are seen in the cases of absence of one or more sinuses, of which also several cases have been recorded. And with these, as errors of deve
lopement produced perhaps by some accidental presstire, may be enumerated the examples of extreme obliquity or curvature of the septum, in which the apex of the nose is turned corn= pletely to one side or even backwards towards the cheek. Such are the cases for the remedy of which Dieffenbach has lately applied with success the subcutaneous division of the carti lages and the adjacent contracted tissues.§ Another slight defect is that in which part of the septum is deficient, or in which the bone is perforated but is closed by membrane. Haller II describes a case in which the vomer was com pletely and widely perforated ; but much more commonly the defect is in the vertical plate of the ethmoid bone. Very rarely there is an aperture in the cartilaginous part of the septum. The excellent anatomist Hildebrandt had a defect of this kind.11 A class of cases, which, though congenital, cannot be certainly referred to•arrest of deve lopement, are those of fissure of the nose. Sometimes the nose alone is said to be divided deeply in the median plane," and this mav represent the foetal state in which the frontal processes have not united, or in which the septum is not yet formed. But the cases are more numerous in which the fissure exists on one or both sides of the face. In Some it extends from the angle of the mouth, through one or both alw of the nose, to the intelmal or external angle of the eye, laying into one' the cavities of the mouth, nose, and one or both orbits. Four such cases, differing but little from each other, are recorded by Vrolik. He possesses also an example in which, in a much less degree of the same defect, there is only a fissure of the skin from the mouth to the eye by the side of the right ala nasi ; and another, in which a deeper fissure extends in the same direction on both sides. These cases, how- ever, like thos,e Of hare-lip, cannot be regarded as mere arrests of developernent: there is no period in which the foetus is known to present these as normal conditions.