Page 56 - An essay on the diseasesof the jaws, and their treatment

34 AN ESSAY ON THE In some rare instances, a spontaneous cure may take place in consequence of nature timely removing the exciting causes, or the primary affection dependent upon them; but more commonly the disease at some period or other changes into a more violent stage, and becomes fistulous or otherwise complicated. OF FISTULOUS PERFOEATIONS AND ABSCESSES OF THE JAWS. In this form of the disease, the lining membrane of the bone having not unfrequently been destroyed by the constant and protracted inflammation and suppuration, the absorbent ves- sels of the surrounding parts lose their energy and fulfil their offices very imperfectly, the cavity becomes loaded with matter, and the internal cellular structure, particularly if the under jaw be the seat of the disease, becomes more carious ; the pus becomes very foetid, has a greenish or blackish appearance, and is very acrid. Those parts of the jaw which are most acted upon by the chemical power of the matter, either from their situation, or from the nature of their structure, are gradually destroyed, the cheek becomes red and inflamed, and assumes an erysipelatous ap- pearance.* In the upper jaw, the matter generally perforates the outside of the gums, or makes its way below the cheek bone and through the outside of the cheek. See " Principles of Dental Surgery," cases 26 and 25. In the under jaw, the disease very frequently first produces a this means prevented, but the relief afforded is very partial, and the outlet so formed not being sufficiently free, distension to a certain extent continues, accom- panied with much discomfort and suffering. The lower jaw is frequently so much degenerated as to appear like a mere bag of matter, the cancelli and laminse of the bone being penetrated and destroyed. * Fistulous openings and sinuses are very commonly connected with carious or necrosed bone ; and, indeed, diseased bone will generally be found at the bottom of fistulous openings. A curious instance of this occurring in the mouth, is nar- rated by Sir Benjamin Brodie, in his clinical lectures : " A patient once came to me who had a little ulcer formed over the symphisis of the lower jaw, which had resisted all methods of cure. I introduced a probe and found that it passed along a sinus which led up to the base of a diseased molar tooth, very near the angle of thejaw. The tooth was extracted, and the ulcer presently healed."— ("Lancet,'V 1834-5.) I