Volume 1

A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South.

  • Maximilian Joseph von Chelius
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South. Source: Wellcome Collection.

    955/1006 (page 771)
    ture outwards, and the horizontal surface of the temporal bone upwards, Most commonly both condyles are dislocated together, but frequently only one or other. At the moment when the dislocation occurs, the separation of the two jaws is very great, but gradually it diminishes to an inch or an inch and a half; the incisive teeth of the lower jaw project more than those of the upper, the lips cannot be closed, the spittle pours out in large quantity, the pronunciation of the tones, especially of the lip tones is pre- vented ; adepression is observed in front of the ear-passage ; on the inner side of the cheek a projection caused by the coronoid process ; the natural prominence of the m. masseter is flattened. If the dislocation be only on one side, the chin is drawn in the opposite direction; on one side only, is the depression before the ear-passage observed, and the lips may be more closed; the speech, however, is faltering. If the dislocation be not reduced, the jaws often remain fixed in the separation already mentioned, but the patient gradually acquires the capability of speaking more dis- tinetly, and of retaining the spittle, and swallowing with less difficulty. Chewing remains impossible, and the patient must be fed with fluid food; but in some cases the capability of chewing hard food has returned ( Boyer.) 1003. Dislocation of the jaw takes place in some persons very easily, but never in children, on account of the peculiar form and direction of the jaws. Its cause is either external violence, which thrusts the chin down- wards and backwards, when, at the same moment the muscles raising the jaw, especially m. masseter and pterygoideus internus contract; or violent straining in vomiting or yawning, by which the chin is violently drawn down, and by the simultaneous action of m. pterygoider externi projected forwards. 1004. eduction when effected early is easy. The patient should be seated on a low seat and his head pressed by an assistant against his breast. The two thumbs, wrapped in linen, are then to be carried as far back as possible, between the hind teeth, and put upon their crowns, whilst the fingers placed beneath the chin bring it forwards and raise it at the same time. If the dislocation be only on one side, the reduction is to be per- formed only with one hand, in the way described, but is more difficult than when both condyles are dislocated. For the purpose of acquiring great power in this proceeding, the patient may be seated on the floor (LE Car.) If the reduction cannot be thus effected, a piece of cork may be intro- duced between the hinder teeth and the lower jaw pressed forward against the upper. If the dislocation be only one-sided, the cork is to be applied only on that side. [The readiest mode of reducing a dislocated jaw is, to set the patient on the floor aud fix the back of his head between your knees. Then the handles of a couple of forks, or two round pieces of hard wood of similar size, are to be thrust in, one at each corner of the mouth, between the hind teeth, as far as they can be got. You then place both hands beneath the chin, and drawing it directly and steadily up, the sides of the jaw forming a pair of levers, the contraction of the temporal muscles, which fix the condyles in their unnatural place, is overcome, and the reduction is easily effected. A little knack is requisite to raise the chin evenly, and keep the fork-handles well fixed, otherwise one condyle only will slip in, and the attempt to reduce the other, will often displace that to the annoyance of both patient and Surgeon. If only one condyle be dislocated, it is still best to introduce the fork-handles on both “sides.—J. F. S.] 1005. After the reduction is effected, the lower jaw should be fixed by the 3 D2