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944 DISEASES OF THE PERIDENTAL MEMBRANE.
the antrum of Hiiihmore. The discharge of pus was at the free margin
of the gum ; and if I had not seen the case early, I should certainly have
taken it to be one of alveolar abscess. Except as a matter of accuracy,
this error would tlien have been of no importance ; for it could have
made no diiference in the treatment.
Subperiosteal inflammation occurring under the temporal muscle,
especially if it be in the temporal
Fig. 503. fossa, will usually discharge its
pus into the mouth near the last
molar tooth of the upper jaw, or
it will appear on the face from
under the zygomatic arch ; and
if the case be somewhat chronic,
it may be mistaken for alveolar
abscess. The temporal muscle is
covered by a very dense fascia
w^liich prevents the pus from com-
ing to the surface, and the fibres
of the muscle will carry it in the
direction indicated. In two cases
/,jaa I have met with there was very lit-
tle pain complained of in the tem-
Loss of Bone and Teeth from Subperiosteal Inflam
mation. poral region ; both were fatal from
the resulting necrosis of the skull.
In chronic abscess discharging at any distance from the teeth, as on
the lower margin of the lower jaw or on the side of the neck, the
chances that the pus may come from some small point of necrosis
should always receive consideration. I have twice seen such cases, in
which the discharge ^vas in the same region in which we usually find it
when, starting from alveolar abscess, the pus has burrowed into the
tissues of the neck ; in both of these cases the discharge was found to
be caused by necrosis of the ramus of the lower jaw. In the search for
the source of the discharge the condition of the teeth will often materi-
ally aid us. It must always be remembered that it is not necessary
that a tooth be decayed or in any wise painful in order that it may be
the subject of chronic abscess ; but it must have lost its pulp, and there-
fore will not respond to the tests for vitality in that organ. Such a
tooth, also, will very generally show a change of color—will be a shade
or several shades darker than the teeth that are healthy. These points,
in those cases in which the teeth are all seemingly good, will generally
serve to indicate the affected tooth and aid materially in tracing the pus
to its source. It must be remembered, also, that almost precisely the
same symptoms may arise from impacted teeth; discharges from these
very generally occur on the face if they lie deep in the bone. I have
.seen quite a number of these cases, in which the only way of distin-
guishing them from the more common form of alveolar abscess was
the tracing of the sinus and finding in this way the impacted teeth.
The TRE.VTMEXT of alvcoUu' abscess in the vast majority of cases pre-
sents but little difficulty. It consi.sts in the simple cases in the removal
of the irritant that has acted as the cau.se i. e. septic matter from the
944 DISEASES OF THE PERIDENTAL MEMBRANE.
the antrum of Hiiihmore. The discharge of pus was at the free margin
of the gum ; and if I had not seen the case early, I should certainly have
taken it to be one of alveolar abscess. Except as a matter of accuracy,
this error would tlien have been of no importance ; for it could have
made no diiference in the treatment.
Subperiosteal inflammation occurring under the temporal muscle,
especially if it be in the temporal
Fig. 503. fossa, will usually discharge its
pus into the mouth near the last
molar tooth of the upper jaw, or
it will appear on the face from
under the zygomatic arch ; and
if the case be somewhat chronic,
it may be mistaken for alveolar
abscess. The temporal muscle is
covered by a very dense fascia
w^liich prevents the pus from com-
ing to the surface, and the fibres
of the muscle will carry it in the
direction indicated. In two cases
/,jaa I have met with there was very lit-
tle pain complained of in the tem-
Loss of Bone and Teeth from Subperiosteal Inflam
mation. poral region ; both were fatal from
the resulting necrosis of the skull.
In chronic abscess discharging at any distance from the teeth, as on
the lower margin of the lower jaw or on the side of the neck, the
chances that the pus may come from some small point of necrosis
should always receive consideration. I have twice seen such cases, in
which the discharge ^vas in the same region in which we usually find it
when, starting from alveolar abscess, the pus has burrowed into the
tissues of the neck ; in both of these cases the discharge was found to
be caused by necrosis of the ramus of the lower jaw. In the search for
the source of the discharge the condition of the teeth will often materi-
ally aid us. It must always be remembered that it is not necessary
that a tooth be decayed or in any wise painful in order that it may be
the subject of chronic abscess ; but it must have lost its pulp, and there-
fore will not respond to the tests for vitality in that organ. Such a
tooth, also, will very generally show a change of color—will be a shade
or several shades darker than the teeth that are healthy. These points,
in those cases in which the teeth are all seemingly good, will generally
serve to indicate the affected tooth and aid materially in tracing the pus
to its source. It must be remembered, also, that almost precisely the
same symptoms may arise from impacted teeth; discharges from these
very generally occur on the face if they lie deep in the bone. I have
.seen quite a number of these cases, in which the only way of distin-
guishing them from the more common form of alveolar abscess was
the tracing of the sinus and finding in this way the impacted teeth.
The TRE.VTMEXT of alvcoUu' abscess in the vast majority of cases pre-
sents but little difficulty. It consi.sts in the simple cases in the removal
of the irritant that has acted as the cau.se i. e. septic matter from the
