Page 43 - An essay on the diseasesof the jaws, and their treatment

— — DISEASES OF THE JAWS. 21 The local exciting causes are, not only those ah'eady stated as the proximate causes of the disease, but also all diseases of the frequent seat of the original irritation, forming as it does the principal connecting medium between the teetli and jaw-bones, and uniting in the most intimate manner, in the cells and Haversian canals of the cancellated substance, by innumerable pro- cesses, with the prolongations of the lining membrane or endosteum of Dr. Walshe. With this irritation of the alveolar periosteum, may be associated fleshy cysts at- tached to the extremities of the fangs of the teeth, or an enlargement of these parts similar to the ivory exostosis of other bones. The morbid action in the perios- teum, in the first instance, does not usually proceed beyond a certain low chronic form of inflammation, but it has all the essential characters of perios- titis, and is always liable to pass into the acute state, and to end in abscess, fis- tula, or necrosis. But this, comparatively, seldom takes place; on the con- trary, the injection of the membrane gradually yields to thickening, its tissue alters to a cartilaginous texture, the structure of the bone is soon involved, and the effusion of cartilage extends within its substance. As the bone becomes en- gaged, it loses its density and gets infiltrated with an albuminous substance, more or less dark in colour, and not unfrequently accompanied by the formation of pus. Ossific matter may also be deposited in these adventitious tissues, and in some cases the morbid action is confined entirely to a deposition of bone. Thus we have in the progress of simple irritation of the membranous investments of the maxilla, materials, as it were, furnished for the formation of every variety of tumour to which the maxillary bones are subject. The different forms in which the diseases of the jaws occurred in the 335 cases contained in the Appendix, were Inflammation 4 Inflammation and suppuration 50 Necrosis 29 Fibrous timiour 24 Fibro-cartilaginous tumour 37 Sarcomatous tumour 43 Osteo-sarcomatous tumour 57 Steatomatous tumour 2 Medullary sarcoma and fungus hsematades 10 Carcinomatous tumour 20 Fungous tumour 32 Bony exostosis 5 Undescribed 22 The morbid anatomy of these diseases ought to throw much light on their nature and origin, but little has hitherto been accomplished in this respect. It has been remarked, however, that the roots of such teeth as are involved in the diseases of the maxilte, when examined, are found highly injected with blood corresponding signs of morbid action being observable in the substance of the tumour. The case of William Thompson—the first in Mr. Liston's paper on the Tumours of the Mouth—furnishes an instance of this. " At the upper part to- wards the alveolar processes," says that gentleman, " it is broken up and bloody- looking, more estpcciully at that part attached to the roots of the decayed violar tooth.'' "I should be inclined to think," he iirocecds, "both from the history of the case, and from the morbid appearances, that the disease had commenced at this point, and extended to the lining membrane of the cavity, which it now fully occupies." —(Transactions of the Medical and Chirurgical Society, v. xx.) Mr, Berard, in the Dktioiinaire de Mcdccine, article Machoire, cites some re-