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Fractures of Bones of the Face

jaw, swelling, splint, fracture, usually and bleeding


Fracture of the Nasal Bones is frequently produced by blows or falls. The swelling and discoloration are likely to be great, and depres sion of the tones will usually indicate the frac ture, the bridge of the nose being broken down. There may be severe bleeding, and headache is likely to result from the accident.

The treatment consists in trying to remedy the depression by the fingers, or by pushing a gum-elastic catheter (see Catheter—MEDICAL AND SURGICAL APPLIANCES) carefully tip the nos tril and trying to replace the bone from within. If the bleeding is excessive it should be stopped by pushing plugs of oiled lint up the nostril. The swelling and headache are to be met by cold applications, and purgatives of some kind of salts. Some time after the injury hot cloths will give more relief than cold applications, 7 though cold is the proper remedy immediately on receipt of the injury, since it tends to arrest bleeding, which heat would only encourage.

Fracture of the Lower Jaw is not uncom mon. It also is due to violent blows or falls; a throw from horseback might easily produce it. The break usually occurs towards the front in the neighbourhood of the eye-teeth, a little to the right or left of the middle line. It may be on both sides, so that a portion of the bone, carrying one or two teeth, is entirely separated from the rest, and held in position only by the soft parts.

Signs.--The fracture is usually easily recog nized by the unnatural power of movement of the part, the grating (crepitus) when the parts are moved against one another, and the irregu larity in the line of the teeth. There are also pain, swelling, and inability to move the jaw. The gums are usually torn and bleeding.

Treatment.—The difficulty is to keep the parts at rest, since that implies moving the jaw as little as possible for from four to six weeks, and therefore interferes with eating and speak ing. A special splint has to be made of paste

board or gutta-percha, the latter being preferred, cut to a particular shape, and moulded to fit the jaw after being softened in boiling water. Fig. 34 shows the shape of the splint; the size should be determined by the jaw to which it is to be applied. The long part (a) of the splint is applied along the jaw from one side to the other, while the shorter piece (b) doubles down under the chin, and should be long enough to permit of its ends projecting from beneath the chin at each side, the projecting ends being then folded up on either side. The gutta-percha should be first cut and shaped to the proper size, taken in paper, and after being thoroughly softened should be quickly applied so that it may take the accurate form of the jaw without trouble. It ought to be kept in position by a four-tailed bandage made of a yard and a half of cotton cloth about four inches wide. The bandage is torn up lengthwise from each end, so as to leave eight inches in the middle, which has a hole cut in its centre to receive the point of the chin. Two of the tails are then brought up, one on each side of the head, and tied over the top of the head; the other two are tied behind the head. The bone must be kept fixed in this way for from four to six weeks. During that period only soft or liquid food should be given, so that no chewing is required, and speech should, as much as possible, be avoided. If the fracture has been attended with much bruising or swelling large soft poul tices should be applied, which will be sufficient to keep the parts in position till the swelling subsides, when the splint may be used.