| FIG. 17. |
| Jarvis's Rhinoscopic Mirror and Tongue Depressor. |
| FIG. 18. |
| RHINOSCOPIC IMAGE. |
| 1. Vomer or nasal septum. 2. Floor of nose. 3. Superior meatus. 4. Middle meatus. 5. Superior turbinated bone. 6. Middle turbinated bone. 7. Inferior turbinated bone. 8. Pharyngeal orifice of Eustachian tube. 9. Upper portion of Rosenmüller's groove. 11. Glandular tissue at the anterior portion of vault of pharynx. 12. Posterior surface of velum. |
THE RHINOSCOPIC IMAGE.—In the middle of the drawing we see a triangular plate with its apex downward; this is the posterior margin of the vomer or nasal septum. On either side we notice curtain-like folds projecting against the septum; these are the posterior aspects of the turbinated bones. On either side of these and on the margin of the drawing we notice pointed elevations projecting toward the interior of the cavity, with a crater-like depression on their apices; these are the lateral pharyngeal walls with the orifices of the Eustachian tubes. Above we see the vault of the pharynx, and below the posterior surface of the velum palati with the uvula.
Another method of examining the laryngeal and naso-pharyngeal cavities, which is especially valuable in cases where neoplasms or impacted foreign bodies hide the parts forming the laryngoscopic and rhinoscopic images, is by means of digital palpation. Even where no obstruction is present the beginner will do well to resort to this method in all cases, for he will thus become better acquainted with the topography of the parts than by inspection only. The procedure is not as difficult nor as disagreeable to the patient as might be imagined, and needs but little description.
When the laryngeal cavity is to be examined by palpation, the head of the patient is thrown back, and steadied in that position by the left hand of the examiner while he introduces the index finger of the right hand into the mouth and slides it along the back of the tongue until the tip comes in contact with the upper margin of the epiglottis. Passing downward along its lateral margin on either side, the ary-epiglottic folds and the tips of the arytenoid cartilages can be felt, and likewise the upper surfaces of the ventricular bands. The vocal cords are, as a rule, too low down to be reached by the tip of the finger. An examination of this kind should of course be made quickly while the patient is holding his breath, so as not to obstruct respiration too long, which in cases of narrowed glottis by neoplasms might give rise to serious results. When the naso-pharyngeal space is to be explored by the finger, the patient's head is bent forward, and the index finger is gently pushed upward between the velum and the pharyngeal wall. When this is accomplished, the velum is drawn forward and the finger pushed along its posterior aspect until the different portions forming the rhinoscopic image are reached and explored by the sense of touch.
DISEASES OF THE NASAL PASSAGES.
BY HARRISON ALLEN, M.D.