. Manual of operative surgery. actures occur in the neighborhood of the posterior fragment is left free. The anterior fragment, if not edentulous, Fig. 97. I. Articular process lower jawrubber ridge representing teeth FRACTURES LOWER JAW 97 is splinted in correct alignment. When the lower jaw is edentulous, no splintis used. Cases have been treated in this way with consistent success. As a preliminary to operation, splinting ought to be fitted and put in place(p. 98). Expose the bone by a suitable incision. Remove tissues interposed betweenthe fragments. Vivify the ends of the bone.
. Manual of operative surgery. actures occur in the neighborhood of the posterior fragment is left free. The anterior fragment, if not edentulous, Fig. 97. I. Articular process lower jawrubber ridge representing teeth FRACTURES LOWER JAW 97 is splinted in correct alignment. When the lower jaw is edentulous, no splintis used. Cases have been treated in this way with consistent success. As a preliminary to operation, splinting ought to be fitted and put in place(p. 98). Expose the bone by a suitable incision. Remove tissues interposed betweenthe fragments. Vivify the ends of the bone. Perforate each fragment with adrill. Wire the fragments together. To do this requires free exposure of thedeep surfaces of the bone and thus involves danger of penetrating the a metal plate is used, denudation of the deep surface of the bone is unneces-sary, but it is imperative to hold the fragments in accurate apposition whilethe plate is being applied. To avoid these troubles Cole combines the plateand wire Fig. g8.—{Cole, Brit. J. of Surg.) Fig. 99.—(Cole, Brit. J. of Surg.) 2. Bone Grafting. A. Free or Nonpedunoulated Graft.—When there is much loss of bone sub-stances, there are commonly much loss of soft parts, much scar tissue and oftenfistulae. Before any grafting may be attempted various plastic operations areessential. Coles description of a concrete case is a model of clearness. Fig. 98 shows the condition of a patient immediately before the plasticoperation was undertaken. A suitable splint was adapted to retain the frag-ments in correct position. A wide exposure of the area was then obtained byfree reflection of the soft parts. The ends of the fragments were exposed, andthe mucous membrane of the floor of the mouth was dissected up and unitedto the mucous membrane of the cheek. Under cover of this the bone ends wereshut off from the buccal cavity, and between them was inserted a piece ofdecalcified bone. The soft parts on the outer aspect of
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