Injuries and diseases of the jaws . eans easy on the subject, even 84 DISLOCATION OF THE JAW. when the parts are dissected, and can only be accomplishedby tearing the structures of the joint very , the position the jaw assumes when the condylesare so driven forward, is not that of the ordinary form ofdislocation, the jaws being too widely separated, and thechin drawn back instead of being advanced. Were thecoronoid processes fixed against the malar bones, it wouldbe impracticable to effect reduction by elevating the chin,as is frequently done ; and, moreover, the gradual im
Injuries and diseases of the jaws . eans easy on the subject, even 84 DISLOCATION OF THE JAW. when the parts are dissected, and can only be accomplishedby tearing the structures of the joint very , the position the jaw assumes when the condylesare so driven forward, is not that of the ordinary form ofdislocation, the jaws being too widely separated, and thechin drawn back instead of being advanced. Were thecoronoid processes fixed against the malar bones, it wouldbe impracticable to effect reduction by elevating the chin,as is frequently done ; and, moreover, the gradual improve-ment noticed in old-standing cases of dislocation would beimpossible. A preparation, illustrating the anatomy of dislocation,which was dissected for me by my friend Mr. Marcus Beck,accompanied this essay, and is now in the Museum of theCollege of Surgeons. From one side of it the drawing(fig. 37) was made. Symptoms of Dislocation.—When the dislocation is bi-lateral, the deformity is so evident as at once to attract Fig. attention. The mouth is open and the jaw fixed, with thelower teeth carried beyond those of the upper jaw, as seen SYMPTOMS OF DISLOCATION. 85 in fig. 38, from Fergusson. Speech and deglutition are muchinterfered with, since the lips cannot be approximated ; and,for the same reason, the saliva dribbles from the examining the neighbourhood of the temporo-maxillaryjoint, a distinct and unusual hollow will be seen immedi-ately in front of the ear, and the condyle may be both seenand felt in front of this. The coronoid process forms aprojection immediately behind and below the malar bone,and may be readily felt in its abnormal position from themouth. The masseter is firmly contracted and stronglyprominent. R. W. Smith, in his work on Fractures andDislocations,^^ has also specially called attention to a promi-nence immediately above the zygoma, which has not beenusually described, and which he believes is due to the condylepressing forward and s
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