Bone-formation after resection of the lower jaw / by B. v. Langenbeck.

  • Langenbeck, Bernhard Rudolph Conrad von, 1810-1887.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Bone-formation after resection of the lower jaw / by B. v. Langenbeck. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    cedes slightly. Some years later, Cornelia S. died of abscess of the brain, and so Dr. Wood acquired the possession of this skull, which stands before you, and upon which you observe the entire lower jaw, with extremely complete form, only a very little smaller than the original must have been. Formerly, cases of phosphorus-necrosis came into the clinic here not infrequently, and scarcely a term passed in which some jaw-resections were not performed. Thanks to the bet- ter ventilation in factories since 1864, scarcely any cases have come under observation, and it appears that phosphorus-necro- sis will, at no very distant time, be eliminated. I have performed subperiosteal resection of the entire low- er jaw six times—four times in consequence of phosphorus- necrosis, and twice in consequence of acute osteo-periostitis. In all these case reformation of new bones was observed, and, indeed, as in the case operated upon by Dr. Wood, with most complete restoration of the function. When one extirpates the entire lower jaw from under the periosteum at one sitting, the chin must invariably recede. The room for the formation of the new lower jaw is restricted by muscles, namely, by the genio-glossi; the contour of the new lower jaw develops imperfectly, and the chin-portion of it retreats more or less perceptibly. In order to obviate this evil, I have, like Dr. Wood, made the operation at two differ- ent times, and at first cut out from the periosteum the smaller poition of the mandibula—which was, however, most diseased leaving the chin and larger portion alone, and then, after four or six weeks, resected the remainder. But even then, as this photograph and the description given by Dr. Wood indi- cate, the lower jaw is always smaller, and the normal promi- nence of the chin is lacking. This evil is almost completely avoided, if, as Billroth has recommended, one leave behind in position osteophytes from the necrosed bone, in immediate contact with the periosteum. This photograph shows you such a case. I cut out first the smaller part of the necrosed jaw-bone, and, after new bone could be distinctly felt—six weeks later—I cut out the greater part, with the chin-portion. The resected jaw here shows )ou that osteophytes were left almost completely around.