Amputation of the entire lower jaw, with disarticulation of both condyles / by Henry J. Bigelow.

  • Carnochan, J. M. (John Murray), 1817-1887.
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: Amputation of the entire lower jaw, with disarticulation of both condyles / by Henry J. Bigelow. Source: Wellcome Collection.

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    tree from ulceration ; the vitiated secretions taking their exit by the cavity of the mouth. . tlie 13tk of a consultation was held, and an opera¬ tion for the removal of the bone decided upon. The for¬ midable nature of the operation proposed, together with the debilitated and cachectic condition of the patient, induced me to enter into full explanations, and to inform him of the great risk that would attend it. The matter was then left toliim- self, and at his urgent request, I proceeded to use my efforts tor his relief. It was not thought expedient to administer either chloroform or ether, on account of the liability to as¬ phyxia from the passage of blood into the wind-pipe. The patient being seated on a chair, and the assistants pro¬ perly ananged, an incision was first made, commencing op¬ posite the left condyle, passing downwards towards the angle of the jaw, ranging at about two lines in front of the posterior border of the ramus, and extending thence along the base of the jaw, to terminate by a slight curve on the mesial line, half an inch below the free margin of the lower lip. The bone was now partially laid bare, by dissecting upwards the tissues of the cheek, and by reflecting downwards, for a short- distance, the lower edge of the incision. The tissues forming the floor of the mouth, and situated upon the inner surface of the body of the bone, were separated from their attachments from a point near the mesial line, as far back as the angle of the jaw. The attachments of the buccinator were next divided. The facial artery, the sub-mental and the sub-lingual, already cut, were then secured by ligature. It was now seen that the bone was partially separated at the symphysis, and that the necrosis was complete from that point to the inferior portion of the ramus. The ramus itself was found diseased ; the pe- liosteum externally was inflamed, and in some parts easily detached. The tongue was now grasped and held forwards, while the attachments of the genio-hyo-glossi muscles were divided. A double ligature was passed through the anterior pait of the root of the tongue, and entrusted to an assistant, in order to prevent its retraction upon the superior orifice of the larynx. A fatal case from the falling backwards of the tongue, occurred a few years ago, in the practice of an emi-