SEPTAL DISPLACEMENTS IN THE VERY YOUNG.
Douglas Macfarlan, M. D.,
Philadelphia.
ONE does not often see obstructing septa in the young and it is difficult to say just why this is so. Children probably have
as many. if not more, falls and bumps on the nose than adults,
but possibly because the septum is more elastic and resilient, less firm
and chondrosed as later, deflections do nat arise. Displacement of
the nasal bones is not unusual in the young, The condition demands
the greatest nicety to restore correct position, a fact of much importance in the later appearance of the patient. Saddle nose and a broad-
based nose are apt to appear in the poorly corrected case of nasal fracture, and with this there is usually seen a buckling of the triangular
cartilage as in the adult years the face develops.
As to remedial measures, operations for correction, more particularly, submucous work is usually impractical in children under twelve. The parts are small; they have not yet reached their growth, and the age of the subject does not readily lend ta operative measures. This work under local anesthesia is practically impossible. The old breaking operations are unscientific and give poor results. Correction by pressing the septum over with the index finger in the nostril on the side of the deflection works admirably and the results are quite permanent. It might be supposed that the resiliency of the cartilage would result in its springing back in its old place, and it is well to guard against this by introducing an intranasal splint on the side of the deflection. This splint, if used, should be of a comfortable size, and should be frequently removed (daily) for cleansing the nose. The mucosa should be watched for the first suggestion of ulceration.
To repeat, the resiliency of the cartilage in the young is not marked and the replacement of the deflection by forcing it over by pressure to the mid line will in a few weeks be found permanent. It is a good practice to have the patient come twice a week to have this digital pressure applied, the period between allows any reaction to
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