A practical treatise on fractures and dislocations / by Frank Hastings Hamilton.
- Frank Hastings Hamilton
- Date:
- 1891
Licence: Public Domain Mark
Credit: A practical treatise on fractures and dislocations / by Frank Hastings Hamilton. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
102/858 page 108
![The following procedures, the value of which I have been able to determine by experiment upon the living subject in two or three cases, and which I have carefully and frequently tested upon the cadaver, are suggested: Attempt to lift the bone by putting the thumb under its zygomatic process and body within the mouth. If the bone is thrown directly downward, or downward and backward, this method can scarcely fail; and even when it is thrown downward and forward, so as to press into the antrum, it is likely to succeed. If, however, for any reason, the thumb cannot be brought to bear upon its under surface, make a small incision upon the cheek over the anterior margin of the masseter muscle, where its insertion into the malar bone terminates, and pushing a strong blunt hook under the bone, lift it. Where the depression of the malar bone is in the direction of the an- terior and superior angle, these means may not be found available, and we may then employ a screw elevator. The instrument ought to be made of the best steel, and with a broad, sharp-cutting thread. A slight in- cision being made through the skin, and down to the centre of the malar bone, the elevator is then screwed firmly into its structure, and now its elevation and adjustment may be accomplished with the greatest ease. In some instances, where fragments are displaced, carrying with them several teeth, while others in the same row remain firm, it will be suffi- cient to close the mouth and apply a bandage as for fracture of the inferior maxilla; in others, the teeth and their alveoli ought to be fastened with silk, or gold or silver thread ; gold, silver, gutta-percha, or vulcanite clasps may be applied to the teeth and jaw. In a case of fracture of the right superior maxilla, reported by Baker, of Norwich, N. Y., complicated with a fracture of the inferior maxilla, the alveoli were retained in place very perfectly by a mould of gutta-percha. Neill, of Philadelphia, has also reported three cases of fracture of the bones of the face, involving the superior maxilla, in two of which the eyes were made to protrude more or less from their sockets. The loosened alveoli were made fast by wire. The subsequent deformity was inconsiderable, yet in no instance was the restora- tion complete. The same method was adopted successfully by a surgeon in Virginia, in the case of a negro fifty years old, where most of the teeth of the left upper jaw were forced into the mouth, carrying with them their correspond- ing alveolar processes. The teeth remained firm in their sockets, but the separ- ation of the bone was complete, the fragment being held in place only by the mucous membrane of the mouth. On the eighth day the surgeon found that the negro had removed the wire, and also the.cork from between his teeth, and the maxillary bandage; but the soft parts had already united, and the bones showed no tendency to displacement. His recovery was speedy, and it was accomplished without any further treatment. [Marshall, of Chicago, reports two cases of fracture and diastasis of the superior maxillse and upper bones of the face successfully treated with the aid of the inter-dental splint. In both cases the cause was a crushing blow which drove the maxilla inward. The apparatus employed was adapted on the principle of Kingsley's inter-clental splint, and gave excellent results.1] 1 Journ. Amer. Med. Assoc, 1888, vol. ii.](https://iiif.wellcomecollection.org/image/b21056699_0102.jp2/full/800%2C/0/default.jpg)
