Page 824 - My FlipBook

822 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.

desired degree ; while the movement and inclination of the crowns are
under the perfect control of the operator.
In this operation it will be found in a majority of cases, and espe-
cially with those which are begun as early as thirteen or fourteen years
of age, that the entire intermaxillary portion of the upper jaw may be
carried bodily forward with the roots of the incisors.
The depressed features of the physiognomy—in segments 1 and 2
—that are dependent for their contour upon that portion of the max-
illae are thus brought into perfect harmony with other features of the
face.
It is not here implied that there are not many cases of real prog-
nathous jaw where its retraction, if possible, would produce a most
desirable result ; nor that such an operation is impossible if recognized
and treated sufficiently early with properly adjusted apparatus per-
sistently worn. The body of the lower jaw can certainly be forced back
to a more posterior position in its relations to the upper, partly by bend-
ing the rami and necks of the condyles, and partly by absorption of the
posterior wall of the glenoid fossse.
The many failures that have attended these operations have been
largely due to the advanced age of the patients and much to the fact
that the apparatus is dependent upon the will or caprice of the patient
for its persistent application.
On account of the early maturity and ossification of the lower
maxilla, these operations should be undertaken as early as from five to
ten years of age.
The caps fitted to the head and chin should be made to exert a uni-
form pressure over the surfaces upon which they rest, admit of free
ventilation, and the whole apparatus when in place should have no
projecting parts which will interfere with the comfort of the patient at
night.
Fine wire gauze answers admirably for the body of caps. It can be
cut and readily shaped to any contour. First cut a narrow pattern of
thick paper to accurately fit the zone indicated by the desired border of
the skull-cap. Duplicate this in thin tin ; solder the free ends together
and fit to the head to see that it takes the proper position and desired
flare. Cut the pieces of gauze a little in excess of the required size
and force it into the rim, where it should be tacked at one point only,
with soft solder. The adjustment is finally perfected by again fitting it
to the head and a line drawn along the borders where it is to be com-
pletely soldered. In constructing the chinpiece, first make a frame of
German-silver wire, which is then soldered to gauze as shown in Fig.
868—the whole to be shaped to produce an even pressure upon the
chin.