obstruction: _Adenoids_--Tumours of naso-pharynx.

[6] Revised by Dr. Logan Turner.

#Fracture of the Nasal Bones and Displacement of the
Cartilages.#--These injuries are always the result of direct violence,
such as a blow or a fall against a projecting object, and in spite of
the fact that the fracture is usually compound through tearing of the
mucous membrane, infective complications are rare. The fracture
usually runs transversely across both nasal bones near their lower
edge, but sometimes it is comminuted and involves also the frontal
processes of the maxillae. In nearly all cases the cartilage of the
septum is bent or displaced so that it bulges into one or other
nostril, and not infrequently a haematoma forms in the septum (p. 573).
Sometimes the perpendicular plate of the ethmoid is implicated, and
the fracture in this way comes to involve the base of the skull. The
nasal ducts may be injured, obstructing the flow of the tears, and a
lachrymal abscess and fistula may eventually form.

The _clinical features_ are pain, bleeding from the nose,
discoloration, and swelling. Crepitus can usually be elicited on
pressing over the nasal bones. The deformity sometimes consists in a
lateral deviation of the nose, but more frequently in flattening of
the bridge--_traumatic saddle nose_. Within a few hours of the injury
the swelling is often so great as to obscure the nature of the
deformity and to render the diagnosis difficult. Subcutaneous
emphysema is not a common symptom; when it occurs, it is usually due
to the patient forcing air into the connective tissue while blowing
his nose. The lateral cartilages may be separated from the nasal bones
and give rise to clinical appearances which simulate those of
fracture. Sometimes the septum is displaced laterally without the bone
being broken, and this causes symptoms of nasal obstruction.

_Treatment._--As the bones unite rapidly, it is of great importance
that any displacement should be reduced without delay, and to
facilitate this a general anaesthetic should be administered, or the
nasal cavity sprayed with cocain. The bones can usually be levered
into position with the aid of a pair of dressing forceps passed into
the nostrils, the blades being protected with rubber tubing. After the
fragments have been replaced and moulded into position, it is seldom
necessary to employ any retaining apparatus, but the patient must be
warned against blowing or otherwise handli