War surgery of the faceA treatise on plastic restoration after facial injury by John BRoberts ..Prepared at the suggestion of the subsection on plastic and oral surgery connected with the office of the surgeon generalIllustrated with 256 figures . cedthrough the nostril, is used with the other hand to lift the frac-tured parts into proper relations with the rest of the nose. Afterthe lapse of four or five days such manipulation becomes con-stantly more and more difficult, because of the rapid union of thebones, cartilages and mucous membrane in abnormal positions. GUNSHOT AND OTHER FRACTURES O
War surgery of the faceA treatise on plastic restoration after facial injury by John BRoberts ..Prepared at the suggestion of the subsection on plastic and oral surgery connected with the office of the surgeon generalIllustrated with 256 figures . cedthrough the nostril, is used with the other hand to lift the frac-tured parts into proper relations with the rest of the nose. Afterthe lapse of four or five days such manipulation becomes con-stantly more and more difficult, because of the rapid union of thebones, cartilages and mucous membrane in abnormal positions. GUNSHOT AND OTHER FRACTURES OF THE FACIAL HONES. 187 The broken and overlapped septum is similarly replaced withcomparative ease. Its anterior portion should be grasped witha large forceps with flat parallel blades like the Adams forceps,and pulled forward; at the same time the posterior angular endof the anterior fragment should be tilted upward by depressingthe handle of the forceps. This maneuver lifts the quadrangularcartilage and any attached portions of the vomer or ethmoid bonesup into place and gives support to the nasal bones and lateralcartilages. Depressions in the line of the dorsum of the noseare thus eliminated. Any lateral deviation of the broken septum. Fig. 74.— Deviations of septum from old fractures of nose.(Mutter Museum.) (From Roberts and Kelly on Fractures.) should be corrected at the same time, and thus occlusions of thenares and nasal chambers removed. Internal nasal splints, orpins, or perhaps springs or pads adjusted to the outside of thenose, so as to make appropriate pressure, may be needed to main-tain the corrected position of the injured tissues. The lastnamed instruments may be attached to head bands. They are,however, seldom if ever required. Nasal pins or intra-nasal sup-ports are less conspicuous, and, if judiciously adjusted, answerthe purpose well in nearly all cases. Instead of the pin a rubber l88 WAR SURGERY OF THE FACE. thread may be carried across under the repl
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