DISEASES OF THE NOSE Congenital Anomalies.—Congenital narrowing and complete oc clusion of the nares are not so infrequently observed. The malforma tion, whether unilateral or bilateral, may involve the external nasal orifices. the nasal passages, and especially the posterior nares. Besides these, there are frequently found other malformations, which distinguish them from congenital adenoid growths of the pharynx. The obstruc tion in the posterior nares is, in most instances, osseous, more rarely membranous. In bilateral closure of the nares, a rapidly fatal asphyxia may occur after birth, since the newborn infant does not know how to breathe through the mouth, or a severe form of inanition may result in consequence of interference with nursing. Severe asphyxia in the newborn after birth, with impaired breathing and aspiration of the cheeks, with closed mouth, should lead US to think of this condition. If on opening the mouth and retracting the tongue, respiration becomes established, the obstruction is in the nose or nasopharynx. Examination by means of the air-douche and probe determines the site and nature of the nar rowing or occlusion, respectively.
Whenever the anomaly causes severe asphyxia an attempt should be made at first to pierce the obstruction with a strong sound or trocar and to dilate gradually. In unilateral or partial closure the interfer
ence with respiration is often not of a serious nature, and only later leads to the need of medical advice. Improvement may take place spontaneously.
Deflections of the nasal septum frequently develop in children, in part as the result of trauma, from which also the external nose may suffer, in part spontaneously, in the course of years, from asymmetrical development of the bones at the base of the skull and the upper jaw. The deformity usually involves the anterior and inferior portion of the septum, and consists in a slight or considerable bending or crooking to the left or right with a horizontal axis. The diagnosis is readily made.
Only considerable curvatures and hypertrophies lead to interference with respiration, imperfect chest development, and even faulty forma tion of the orbits with astigmatism, etc. In such cases, in older chil dren, a resection of the septum is to be taken into consideration, or eventually the removal of an inferior turbinated bone. In the milder cases, which are the most numerous, no treatment is required.