consists in raising flaps from the
cheeks and bringing them together in the middle line.

The whole of the nose, including the cartilages and bones, may be
destroyed by syphilitic ulceration or by lupus. In parts of India the
nose is sometimes cut off maliciously or as a punishment for certain
crimes.

In reconstructing the nose it is necessary to provide skin, a
supporting structure in the form of cartilage or bone, and an
epithelial lining. In the "Indian operation" a racket-shaped flap,
including skin and periosteum, is turned down from the forehead and
fixed in position, the edges of the flap being inturned to provide a
lining for the passage. An implant of free cartilage may be necessary
to support the skin flaps and to prevent subsequent contraction.
Flaps of skin may be formed by Gillies' tube-pedicle method from the
cheek, the forehead, or the neck, and utilised to form the covering of
the nose. When the deformity cannot be corrected by operation, the
appearance may be greatly improved by wearing an artificial nose held
in position by spectacles.

The term #Rhinophyma# has been applied by Hebra to a condition in
which the skin of the tip and alae of the nose becomes thick and
coarse, and presents large, irregular, tuberous masses on which the
orifices of the sebaceous follicles are unduly evident--_potato_ or
_hammer nose_ (Fig. 266). The capillaries of the skin are dilated and
tortuous, and the nose assumes a bluish-red colour, and its surface is
soft and greasy. The condition is met with in elderly men, and the
masses appear to be chiefly composed of sebaceous adenomas. The term
_lipoma nasi_, formerly employed, is therefore misleading.

[Illustration: FIG. 266.--Rhinophyma or Lipoma Nasi in man aet. 65.]

The treatment consists in paring away the protuberant masses until the
normal size and contour of the nose are restored, care being taken not
to encroach on the cartilages or on the orifices of the nostrils.
There is comparatively little bleeding, and the raw surface rapidly
becomes covered with epidermis.

#Examination of the Nasal Cavities.#--For the examination of the
interior of the nose the following appliances are necessary: A
reflector, such as is used in laryngoscopy, attached to a forehead
band or spectacle frame; one of the various forms of nasal speculum; a
long, pliable probe; a tongue depressor; and a small-sized mirror. As
additional aids, a 10 per cent. solution of cocain, a grooved pr