Page 31 - An essay on the diseasesof the jaws, and their treatment

DISEASES OF THE JAWS. 9 under maxilla ; independently of this, it is in itself appalling, dangerous, and certain in many cases to prove of a fatal character; and even in its more successful instances, not unlikely to be fol- lowed by a total loss of future comfort.* Although it is quite unnecessary to dwell upon the risk usually accompanying this operation, yet a peculiar danger to which it exposes the patient should not be passed unnoticed, namely, that of the retraction of the tongue by the glosso-pharyngei muscles, after having lost the couater-action of the geneo-glosd, in con- sequence of which, sudden death may ensue from the suspension of respiration. This fact, it would appear, was first pointed out by the German surgeons, who considered it a sufficient reason for abstaining from the operation, and M. Delpech has confirmed the • At the time the above remarks were written, the operation of excision of the superior maxillary bone was liardly introduced; M. Gensoul's first ojMjration, although performed so early as IMay, 1827, not being known in this country, and Mr. Lizar's first attempt, which was interrupted by ha;morrhage, having been made in December, 1827, only a few months previous to the publication of this essa}'. The excision of the inferior maxilla had been performed in 1812, by Baron Dupuytren, in 1821, by Dr. Mott, again, in 1824, by Baron Dupuytren, and, subsequently, by several other eminent surgeons; but was still looked upon as a novelty. Since then, however, every surgeon has become familiar with these operations, and, indeed, a few years ago the amputating of jaws had become quite a fashion. Mr. Listen, in his Paper on the Tumours of the Mouth, in the " Transactions of the Medical and Chirurgical Society," states, that, up to 1836, there were fifteen cases of excision of the upper jaw on record, with eleven deaths and four recoveries. This great amount of mortality was chiefly owing, as that gentleman has shown, to the malignant character of the cases operated on—a point of the greatest importance—first insisted on by Sir. Listen, from attention to which the surgeons of the present day have greatly reduced the rate of mortality; but it must be confessed, that they have thereby considerably limited the proportion of cases fit for operation, and consequently greatly swelled the lists of the hopeless and incurable. M. Woenkner, in the "^fed. Annal. von Heidelberg," for 1838, gives an account of the operations per- formed on the lower jaw up to that year. Acccording to his statement, there were, from 1810 to 1830, sixty-one resections in the continuity of the bone; from 1793 to 1831, eighteen with disarticulation; and from 1831 to 1838, eighteen of both kinds. I am inclined to think, that among these ninety -seven cases of re- section, are included many minor operations, which in this country would bo styled excision of the alveolar processes. From the Catalogue of cases given in the Appendix, it will be seen that within the last twenty years the operation of the excision of the body of the maxillaj has been performed in the upper jaw at least fifty-eight times, and in the under jaw no fewer than seventy times. M. Wcenkncr's statement, that of the eighteen patients operated on between 1810 and 1830, eleven recovered and five died, while of the eighteen submitted to excision, between 1831 and 1838 only two died, would go to prove the progressive limitation of the operation to non-malignant aflections.