Injuries and diseases of the jaws . cases uncomplicatedby destruction of the cheek itself. The only drawback to this mode of treatment, and onewith regard to which it contrasts unfavourably with Esmarchsproceeding, is the amount of pain which the patient must, of 348 CLOSURE OF THE JAWS. necessity, undergo during tlie after-treatmcut. It requiresno small amount of courage on the part of the patient^ andsome determination on the part of the attendant, to carry outthe necessary manipulations within the mouth, more par-ticularly during the first few days after the operation ; andeven after the sh
Injuries and diseases of the jaws . cases uncomplicatedby destruction of the cheek itself. The only drawback to this mode of treatment, and onewith regard to which it contrasts unfavourably with Esmarchsproceeding, is the amount of pain which the patient must, of 348 CLOSURE OF THE JAWS. necessity, undergo during tlie after-treatmcut. It requiresno small amount of courage on the part of the patient^ andsome determination on the part of the attendant, to carry outthe necessary manipulations within the mouth, more par-ticularly during the first few days after the operation ; andeven after the shields are fitted to the mouth, they causesome pain and inconvenience, which only those who havearrived at years of discretion will submit to. Fig. 159 shows the form of the silver shields adaptedto the upper and lower jaws by INIr. Clendon, late dentalsurgeon to the Westminster Hospital, in a case of Mr. Bar-nard Holt^s. The patient was a girl of seventeen, and wasunder Mr. Holts care in 1862, having five years before had Fig. fever, with an abscess of the cheek on the right side, whichled to such contraction and adhesion of the mucous mem-brane to the jaw as to cause great difficulty in opening themouth. Some attempts had been made to open her mouthby the screw, &c., and in 18G0 Mr. Holt divided some ofthe cicatrix with temporary benefit. Mr. Holt now dividedthe cicatrix within the cheek freely under chloroform, andencountered a firm plate of bone extending between thealveoli of the two jaws, which necessitated the use of a sawfor its division. Mr. Clendon subsequently fitted the above-mentioned shields to the teeth, and wedges were graduallyintroduced between them to separate the jaws. This treat- CLOSURE OF THE JAWS. 349 mcnt was continued for three mouths, when she was able toopen the mouth to the full extent, as seen in fig. IGO. Thecase (No. XXXIV.) will be found in the Appendix. The effect of the use of the shields seems to have been,not merely to prevent adhesions
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