FRACTURE OF LOWER JAW. 37 



ment tends manifestly to injury : on account of the swelling of the 

 limb, it produces pressure, which may occasion ulceration or slough- 

 ing. It is called the immovable apparatus. 



The diet should be watched, and antiphlogistic means resorted to, 

 if necessary. At the end of three to six weeks, the provisional 

 callus is complete, and the substitutes for this splint of nature can 

 be discontinued ; the use of the part must be resumed gradually, 

 especially in the lower limbs. 



FRACTURE OF THE NOSE. 



The nasal bones are usually fractured by a fall, a violent blow, 

 or kick of a horse, or some direct application of force. This frac- 

 ture is often attended by injury of the brain, and followed by caries 

 and exfoliation. 



Treatment. — This consists of antiphlogistic means, such as 

 leeches, cold applications, and rigid diet, to remove swelling and in- 

 flammation, and the adjustment of the fragments ; which can be ac- 

 complished by a catheter, probe, or dressing forceps. The nose 

 should not be plugged with lint, unless to check profuse hemorrhage. 



FRACTURE OF THE MALAR AND SUPERIOR MAXILLARY BONES. 



These, can only occur by the most direct violence, or gunshot in- 

 juries, and are usually attended with crushing and wounding of the 

 soft parts ; severe inflammation and nervous symptoms may come on, 

 and the brain may also be affected. There will be great pain and 

 difficulty in chewing. 



Treatment. — Tf there is no displacement, there is nothing to be 

 done but to subdue inflammation, and keep the parts quiet. If the 

 alveolar processes are loosened, they must be pressed into their 

 places, and the mouth kept shut, and the patient nourished by fluids. 



FRACTURE OF LOWER JAW. 



This may occur in the middle of the base of the jaw, in the 

 ramus or processes ; and in children it may take place at the sym- 

 physis. The most frequent seat of fracture is between the chin 

 and the insertion of the masseter muscle ; the longer fragment and 

 the chin are depressed. In double fractures, the chin alone is de- 

 pressed. There is pain, swelling, inability to move the jaw, irregu- 

 larity of the dental arch, crepitus, and frequently hemorrhage and 

 deafness. 



The diagnosis of fracture of the ramus and condyle is often ob- 

 scured by swelling; the neck of the condyle is drawn forwards by 

 the external pterygoid muscle, and crepitation will be perceived by 

 the patient. 



Treatment. — The teeth serve as a guide in the adjustment of the 

 fragments, and the upper jaw acts as a splint in the retention, A 



