A CASE OF FRACTURE OF THE NASAL BONES TREATED BY 
AN IMPROVED pp&llOD. 
LEWIS D. MASON, M.D. 
Since demonstrating my operation for depressed fractures 
of the nasal arch, before the Anatomical and Surgical 
Society, I have been enabled through the courtesy of my 
colleague Prof. Jarvis S. Wight, M.D., to test its merits on 
the living subject, and take pleasure in presenting the 
notes of the case as reported by Dr. Beasley, House Sur- 
geon to the Long Island College Hospital. 
John Grady, set. 14, U. S., school-boy. On April 5, 1880, fell 
from a wagon, striking upon his forehead and face, sustaining in 
addition to contused and lacerated wounds of forehead, and up- 
per lip, a compound and comminuted fracture of nasal bones, 
with fracture of nasal processes of sup. maxillae. He entered the 
Long Island College Hospital for treatment the following day, 
April 6th, and was seen by Prof. Wight, then on duty, who re- 
quested Dr. Mason to take charge of the case and perform his 
special operation, for fractures of this class. 
The patient was etherized, in the presence of the medical class 
and the resident staff of the hospital. A careful inspection of the 
fractured bones was made. The nasal processes of both superior 
maxillae were involved. The line of fracture of left was near the 
base of the process, on the right side near its middle. The bridge 
was very much depressed and flattened. The right nasal bone 
was lateralized to the right, and made a small puncture through 
skin on that side. There was considerable oedema of eyelids, and 
the face was somewhat puffy. Viewed from either side the de- 
formity was very great, the end of the nose seeming to be at right 
angles to the depressed bridge. 
After elevating the depressed fragments, and overcoming the 
deformity as much as possible, in the usual manner, Dr. Mason 
passed an ordinary surgical needle (ground to a drill point) through 
the line of fracture on either side, thus supporting the nasal 
arch. 
To complete the dressing and give it further stability, a piece 
of thin rubber about half an inch wide was slipped over the head 
and point of needle, and rendered moderately tense, so as to ex- 
ert a gentle compression. Small pieces of cork were placed on 
the head and point of needle to protect the face. 
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LEWIS D. MASON. 
The patient was placed in bed, head slightly elevated and evap- 
orating lotions of an agreeable temperature applied to face and 
nose over the dressing. 
With the exception of some suppuration from the wound upon 
the forehead, oedema of face, and a smart secondary hemorrhage 
from coronary artery of upper lip, the case progressed favorably 
until the eleventh day, on which date the needle was easily 
removed without an anaesthetic, and without pain to the patient. 
At this date there is a slight ulceration at seat of needle punc- 
tures, but of so slight a character, that the cicatrix if any, will be 
scarcely noticeable. 
The contour of the nose is excellent over site of needle, a slight 
periosteal thickening renders the bridge of nose a line or so 
too prominent, but this is observed only on close inspection, and 
will undoubtedly in due time be absorbed. 
At no time subsequent to the operation was there any pain or 
uncomfortable sensation at the seat of the needle. Nor did its re- 
moval cause any suffering. The result may be said to be perfect. 
The boy remains in the ward for future observation, and has 
recovered entirely from his severe fall. 
In commenting upon the notes of the case, I would lay 
stress on the fact that the presence of the needle was not 
at any time painful, nor even uncomfortable to the patient, 
and further that it was easily removed and without pain, 
ether not being necessary. 
The ulceration at the site of the needle puncture was in- 
significant, although the needle remained in eleven days, a 
longer time than was probably necessary. 
The ability to use evaporating lotions over the dressing 
is a valuable quality of this special method, and it afforded 
an opportunity to use intra- as well as extra-nasal appli- 
cations with equal facility. 
Finally I would call attention to the firm and efficient 
character of the appliance, as contrasted with the easily 
disarranged and usually inefficient dressing generally re- 
sorted to in this class of injuries. 
At this date, April 21st, or fifteen days from the date of 
operation, the nose is quite shapely and firm.