Difficult and complicated deformity of the lower maxilla, resulting from long standing necrosis and caries, of doubtful origin, successfully treated. The patient, a male aged 40 or 45 years, lost the two lateral halves of the lower jaw. In conse quence of this the anterior portion of the horseshoe, formed by the jaw, which had yet attached to it the incisors, the ca nines, and the mola.rs of each side, was thrown backward in an inclined position downward, which made it impossible for the teeth to meet, and also caused a very ugly retraction of the chin. By means of splints and plate, and subsequent modi fications, excellent results were obtained, in spite of the carelessness of the patient and many obstacles which seriously in terfered with the prothetie treatment. Martin (Lyon 3led., Mar. 27, '92).
Phosphorus Necrosis.
Symptoms. — Phosphorus necrosis comes on gradually, and sometimes long after the patient has been exposed to its toxic influence in connection with his occupation, the manufacture of matches, etc. But, once started, it progresses rapidly, involving large areas of bone; owing to the general toxwmia, many foci of inflammation may be developed at once. The lower jaw seems to be that in which phosphorus necrosis most fre quently occurs.
Pain is one of the earliest symptoms; at first intermittent, it soon becomes con tinuous. Suppuration of the perialveolar and peridental membranes occurs, pus appears at the alveoli, and the inflamma tion soon includes the gum-structures, the tissues of the face becoming infil trated, and the characteristic deformity appears. The entire periosteal layer is then invaded, sinuses are formed, open ing into the mouth and externally under the lower maxillary edge; and pus is exuded on all sides. The pain becomes less marked when this stage is reached, unless the necrotic process involve the condyle, when severe pain in the ear is experienced.
The general health of the patient soon suffers considerably. The constant dis charge, the presence of offensive pus in the mouth and stomach (much of the dis charge being swallowed), the occlusion of the jaws through infiltration of the maxillary muscles and the impediment to the ingestion of food, combine to rapidly bring on exhaustion and death unless proper treatment be instituted.
in some cases, however, the process is a slow one, and comparative health is enjoyed while now and then a, necrotic sequestrum is discharged through one of the sinuses.
In some operatives, however, a special istti to phosphorus exists, andutt• s\ niptoins nausta and vomiting, L:0. in iitatts an acute poisoning. that rttliarts innin (hate Ltssation of all work N\ hith phosphorus is handled or in I d.
Etiology and Pathology.—The inhala tion of the vapor of phosphorus and the particles of this substance taken in ith the food v. hen the hands are not trly elLansed and improper care of ::,e tt.Ltli combine to very gradually I ring on the general toxfemia. This, in turt . givts rise to slow disintegration of the rttl blood-corpuscles and fatty de g,. titration of the arterial coats. That tbe maxillary bones should, of the entire esst °us system, bear the brunt of the dis tase demonstrates that a local factor must play a prominent part in the disease. lt is thought that the peridental membrane laid bare by accumulation of tartar, and whose vascular supply is already diseased by the general toxremia,„ is easily influ enced by any phosphorus that may enter the mouth. and thus readily yields to the irritation induced, carious teeth and other infectious foci, and that the ne crotic process follows the local inflamma tion engondered.
The so-called phosphorus necrosis of the jaw in match-workers is due to an infection from micro-organisms. In 6 cases examined various organisms were found, none of which could be said to be specific. Tubercle bacilli were found in even- case, moreover; and when death occurs. it is: usually due to tuberculosis of the lungs. The condition is really a tuberculosis of the bone, ingrafted upon a primary lesion. caused by the corrosive action of the phosphorus. Stockman Brit. Med. Jour., Jan. 7, '99).
Phosphorns-vapor exerts no specific irritating influence on the bared perios teum of guinea-pigs, rabbits, or dogs; so that the clinical picture of phosphorus necrosis of man cannot be reproduced ex perimentally in these animals, and the vontlition must be eousidered aS peculiar to man. Stubeurauch (Archly f. klin. :Med., R. 59, 11. 1, '99).
Treatment. — In the early stages the teeth should receive careful attention, carious ones being extracted, while the tartar around those not diseased should be carefully removed. These manipula tions should be conducted antiseptically, strict care of the teeth following.