CHAPTER I
GENERAL CONSIDERATIONS IN REGARD TO OPERATIONS ON
THE NOSE AND NASO-PHARYNX
An intimate knowledge of the surgical anatomy of the nose is an important factor in successful treatment. It is sufficient to recall the close relations of the nasal chambers and their accessory sinuses with the cavities of the orbit and the cranium, and to remember that the shape and size of these air-spaces may vary considerably within physiological limits.
The arrangements of the vascular, lymphatic, and nervous supplies, and their connexion with neighbouring parts and the body generally, have also to be kept in mind.
In planning and carrying out operative procedures it is also well to keep in mind the important physiological functions of the nose.
Disease in the nose involves both medical and surgical treatment. The general progress of surgery, improved technique, local anæsthesia, and the control of hæmorrhage we now possess, have all tended to replace local medication by surgical measures. But in many affections of the nose—such as syphilis, or diphtheria—surgical relief is quite secondary to medical treatment. In any case the surgeon cannot dispense with a knowledge of suitable topical applications and the principles on which they are founded.
SOURCES OF ILLUMINATION
A good source of illumination is the first necessity for satisfactory operations on the upper air-passages. The natural sources at our disposal are sunlight and diffuse daylight. They have the great advantage of not altering the natural colours of the parts examined. Reflected sunlight forms a perfect illuminant, if we are careful not to bring the rays to an exact focus on the mucous membrane, as this might produce a burn.
Diffuse daylight is too feeble for the examination of the cavities of the nose and larynx, but it can be used for inspecting the mouth, pharynx, and ear. Direct daylight is particularly serviceable for examining suspicious rashes or patches in the mouth and pharynx, and eruptions on the skin.
Some form of artificial light is indispensable. That furnished by an ordinary paraffin lamp or a gas flame is sufficient for examination. The flame should have its flat side towards the observer, and be enclosed in a glass chimney, without a globe or shade. If neither of these lights be available, an ordinary candle, or, better still, three candles tied together, will suffice.