Periscope of Medical and General Science in their Relations to Dentistry. [Volume: 2, Issue: 1, August, 1860, pp. 41-50]

48

THE DENTAL COSMIOS.

palate behind the incisors and canines, it was made to bear on the right
side against the displaced teeth and bone, extending still farther backward
and surrounding by a wire the second molar tooth, which had not been
displaced. The plate was so constructed that it exercised pressure only
on the bone and teeth which were displaced, and in an amount in proportion to the displacement-most upon the front of the broken bone and the
first bicuspid, less upon the second bicuspid, and still less upon the first
molar.
"The accident occurred on the seventeenth of April; I first saw my
patient on the nineteenth, and on the twenty-third the apparatus was applied. When the plate was first put on it was very tight, and produced
considerable pressure on the inner side of the fractured bone, causing,
however, a sense of tension rather than pain. In a few hours this feeling
passed off, and when, four days after, I next saw my patient, I found the
position of the parts very much improved. This improvement was followed up, and still more advanced by altering the plate-making it wider,
and by adding portions of gold within the crescentic excavations that received the teeth. From this date, the twenty-seventh of April, my patient
visited me about once a week, the plate having in that time ceased to produce any pressure, or exercise any influence requiring further alterations,
till the second of June, when, as I find from my notes, the maxillary arch
was completely restored to its proper shape.
"After this the plate was worn for many months-longer, I think, than
was required-the patient getting used to it, liking it, and feeling it a
comfort and support. I cannot, therefore, name the precise date when
osseous union may be said to have taken place; but it has taken place,
retaining the fractured bone in a proper position.
"I do not see what other method of treatment could have succeeded in
this case. Probably, had no mechanical support been employed, the
already-existing obliquity of the teeth would have been increased by the
pressure of mastication, and certainly could not have been diminished;
but by the means adopted, stability of the detached bone was secured,
and its position gradually and progressively improved, till it assumed
almost, if not quite, its original place.
"As it seems to me, important as this mode of treating a fracture of the
upper jaw may occasionally become, the same principle as applied to the
lower jaw is of still greater service. Any displacement that accompanies
fracture of the superior maxilla is simply a passive condition: there are
no muscles attached to the upper jaw which can derange or draw out of
place the broken bone. With the lower jaw, however, the case is very
different. The inferior maxilla is a floating bone, to which many powerful muscles are attached, and those connected with the rotating movement
of the jaw-namely, the pterygoids-having a strong lateral antagonistic
action. Destroy the integrity of the maxillary arch by fracture, and that
antagonism ceases; the muscles on either side act independently, and draw
the points to which they are attached more or less to the mesial line, and
this it is which causes the overlapping of the fractured ends of the bone,
often so obstinate, and necessarily with it the traction of the chin toward
the side on which the fracture has occurred in the usual cases, where the
lesion is in the horizontal ramus on one side. A plate or splint, and for
the lower jaw I prefer an ivory one, carved to fit the interior of the arch
of the particular jaw, with small crescentic excavations for the existing
teeth, when placed in the mouth, restores the integrity'of the arch for the