A text-book of minor surgery.

  • Foote, Edward Milton, 1866-
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of minor surgery. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    57/868 (page 23)
    Complications of Fracture of the Lower Jaw.—Fracture of the lower jaw is usually compound into the mouth. It is therefore not surprising that infection sometimes develops. In a certain number of cases this is of mild character; the pus which forms is discharged into the mouth, the wound heals by granulation, and the .union of the fractured bone, although delayed, is not other- wise interfered with. In a good many cases, however, an abscess forms which drains imperfectly and gives rise to pain, swelling and edema of the neck and possibly fluctuation below the margin of the jaw. This is an unfortunate complication, since it may lead to a sequestrum and greatly delay recovery, and possibly make it necessary to perform one or more operations to provide drainage or remove dead bone. It is therefore important to keep the mouth of every patient as clean as possible by the use of astringent and antiseptic mouth washes. If an abscess forms, it should be promptly drained within the mouth if good drainage can be thus secured, and if not, through an external incision. Such an incision should be parallel to the margin of the jaw, and just below it. If the fracture is near the center of the horizontal ramus, the possibility of division of the facial artery or vein should be borne in mind. A drain should be placed in the external wound, but should be of such a character as to favor the escape of pus, and not to prevent it. Frequent irrigation with a solution of peroxide of hydrogen (1:8) assists in keeping the wound free from bacteria. Meanwhile treatment of the fracture itself should be continued as described above. A sinus which has formed spontaneously, or which follows an external incision for drainage usually lasts some weeks. No at- tempt should be made to close the opening in the skin until the deeper portion of the sinus has become filled by granulation. When this takes place, the opening in the skin will quickly close. Persistence of the sinus means that some foreign material is present: either the loosened root of a tooth or a sequestrum of the bone itself. The opening should be enlarged, such foreign mate- rial removed, and another period of drainage instituted. Care should be taken not to break up newly formed bone, which is often thrown out.around the sequestrum in great abundance in cases of compound fracture of the lower jaw. Non-union of the mandible is almost unknown; therefore a