General surgery and pathology for dentists . is called the sequestrum ; itis hard, dry, bloodless, and, unless exposed to the air, white ;its free surface is smooth, its margins ragged, its previouslyattached surface rough and worm-eaten. The separation of the sequestrum from the living bone iseffected by the process of ulceration. The irritation producedby the presence of the sequestrum sets up inflammation inthe adjacent living bone ; a layer of granulation tissue isformed at the line of demarcation between the living and thedead bone ; the leucocytes and osteoclasts slowly dissolve oreat aw
General surgery and pathology for dentists . is called the sequestrum ; itis hard, dry, bloodless, and, unless exposed to the air, white ;its free surface is smooth, its margins ragged, its previouslyattached surface rough and worm-eaten. The separation of the sequestrum from the living bone iseffected by the process of ulceration. The irritation producedby the presence of the sequestrum sets up inflammation inthe adjacent living bone ; a layer of granulation tissue isformed at the line of demarcation between the living and thedead bone ; the leucocytes and osteoclasts slowly dissolve oreat away the opposed surfaces of both the living and the deadtissue, so that when the process is complete, the dead boneis loosened from its attachments. When the sequestrum is PATHOLOGY AND SURGERY. 121 on the surface of the bone, it comes away spontaneously whenthe process of separation is complete {exfoliatioTi)^ but whenthe sequestrum is central or involves the whole thickness ofthe bone, it is usually imprisoned in a dense irregular case of. Fig. 23. NECROSIS OF FEMUR. The sequestrum is enclosed in a thick invohicrum of periosteal new bone perforated by cloacae.(Museum of St. Marys Hospital.) new bone {invohicrum) formed by the periosteum. Theinvolucrum is perforated by several large apertures {cloaccB) L 122 PATHOLOGY AND SURGERY. through which pus escapes (see Fig. 23). When the seques-trum is thus invaginated its release is practically impossiblewithout surgical interference. After the escape or removalof the sequestrum the cavity which is left is slowly filled upby granulations, which ossify and replace the lost bone. ISynvptoms. The symptoms of necrosis are always precededby those of the injury or inflammation of which it is theresult. When suppuration has occurred and the pus has beenevacuated either by natural or artificial means, there remainsa sinus through which a probe can be passed, and the deadbone examined, when it is found to present the charactersalready describe
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