Injuries and diseases of the jaws . n view, the knife is to be applied to the front ofit, when the condyle will be at once dislocated, and theknife can be carried cautiously behind it, so as to isolate forcible wrench of the bone will now tear through the fewremaining fibres of the external pterygoid muscle, and thebone can be removed. At the same time care must betaken not to twist the jaw outwards, so as to force the con-dyle and neck of the bone against the internal maxillaryartery, which might thus be torn. In the case of small tumours this proceeding is sufficientlyeasy, but when the
Injuries and diseases of the jaws . n view, the knife is to be applied to the front ofit, when the condyle will be at once dislocated, and theknife can be carried cautiously behind it, so as to isolate forcible wrench of the bone will now tear through the fewremaining fibres of the external pterygoid muscle, and thebone can be removed. At the same time care must betaken not to twist the jaw outwards, so as to force the con-dyle and neck of the bone against the internal maxillaryartery, which might thus be torn. In the case of small tumours this proceeding is sufficientlyeasy, but when the tumour is large it may so completelywedge in the upper part of the bone as to hinder the freeing 328 OPERATIONS ON THE LOWER JAW. of the coronoid process^ and to prevent dislocation. Underthese circumstances the best plan is to use the bone-forceps,or to re-apply the saw and cut off the tumour as high as maybe, and subsequently to remove the remaining portion ofjaw, if the disease is malignantj but not otherwise. Another Fig. complication is when the tumour breaks away from theupper part of the jaw during the operation, thus renderingit difficult to dislocate the condyle, owing to the want ofleverage. The lion-forceps of Sir William Fergusson isexceedingly useful here, as I have experienced in severalcases. When the central portion of the lower jaw is removed itis well to take precautionary steps to avoid the possibility ofthe tongue falHng back and suffocating the patient. Aligature should therefore be passed through the tip of thetongue, Mhich will enable a trustworthy assistant to keep itdrawn forward until the operation is completed. The liga-ture should then be attached to one of the hare-lip pins with VAEIETY OF INCISIONS. 329 which the wound is closed, and may safely be cut and re-moved on the second or third day. When one half of the lower jaw has been removed someinconvenience is experienced from the remaining portionbeing drawn inwards by its muscles. To obviat
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Keywords: ., bookcentury1800, bookdecade1870, bookpublisherlondo, bookyear1872
