Page 41 - An essay on the diseasesof the jaws, and their treatment

DISEASES OF THE JAWS. itf polypus, spongy, or bony tumour, will often be disappointed by its rapid return, unless the morbid structure of the jaws be also re- moved or cured ; nor will it, in the above instance, be sufficient to attend to the primary disease of the jaw itself, the extirpation of the excrescence or tumour will generally be indispensable. But, on the other hand, if, in such instances, the affected jaw or a part of it be removed, without a proper attention to the consti- tution and the morbid local predisposition of the other parts of the mouth, a return of the disease in the remaining portion of the maxilla. Is just as probable as under either of the former supposi- tions, notwithstanding the amputation may appear at first suc- cessful.* Independently of this, it must be admitted that it is in * There is a case recorded in No. V. of the " Glasgow Medical Journal," and republished in the " Medico-Chirurgical Keview," which strikingly exhibits the truth of this statement. " A female, aged 37, was admitted into the Glasgow Royal Infirmary in 1823, for a fungus of the antrum of the left side, which began two years before, after long-continued toothache. Dr. Anderson destroyed the fungus by exposing the anteHor wall of the antrum, removing the whole of it, scooping out the fungus, and applying the actual cautery to the diseased surface. The cicatrization of the wound, after being a little delayed by the occurrence of ery- sipelas, was ultimately perfect. For more than five years. Dr. Anderson con- tinued to visit this woman, during which time she suffered much from rheuma- tism, and happened to break the neck of the left femur, but had no return of the fungus in the antrum. In Aprillast she complained of toothache in the lowerjaw and a last molar tooth was extracted, soon after which a fungus appeared in that situation. On the 5th of September, Dr. A. saw the tumour, but did not feel war- ranted in operating, onaccoimt of the state of the patient's health, and the suspi- cion that the fracture of the femur had arisen from a malignant diathesis. On the 23rd of October, at the patient's request that something should be done, on account of the repeated hcemorrhages. Dr. A. advised a consultation with his colleagues of the Infirmary. At this time a firm spongy tumour occupied the left side of the inferior maxillary bone, from the symphisis backwards to the angle. It felt soft and elastic ; its upper surface was flat, sloughy, and indented by the teeth of the upper jaw ; it pervaded the whole thickness of the bone ; the grinders on this side were carious, and the whole of the incisor teeth loose; a thinfoetidfluid constantly oozed from tlie mouth, and hoemorrhage had repeatedly occurred to such an extent as to induce syncope. The tumour was occasionally affected with gnawing pain, which extended to the head ; the countenance was sallow, the pulse 110, small, the appetite bad, and the health much reduced." Amputation of the lower jaw was performed, and union took place ; but on the tliirteenth day the patient sank and died of chest affection. The disease in this case, to say the least of it, was attended by caries of the teeth during its entire progress, which could not fail to give rise to a considerable degree of irritation. Had the mouth been kept healthy after the first operation, instead of being allowed to go on from bad to worse, I have no hesitation in say- ing that the patient would have had a much better chance of escaping a relapse and its fatal consequences, to say nothing of the effect of attention to the health of the mouth, from the first, as a curative measure. C2