354 OPERATIONS ON THE DIGESTIVE APPARATUS. 



bone forceps, by nipping oflf fragments from the edges and making 

 entrance into the sinuses of the proper dimensions. The wound 

 and the sinuses are then thoroughly cleaned out, and the blood 

 and the pultaceous pur;ilent collection found in theii* bottom 

 thoroughly removed. This exposes the root of the tooth, in the 

 form of a hard, dry, greyish mass, analagous to a piece of necrosed 

 bone. The operator, then holding the hlunt gouge, or repoussoir 

 in his left hand, apphes it through the sinuses against the middle 

 of the dental root, and with a strong mallet held in his right, 

 strikes upon it with firm and steady blows. The mou.th of the 

 animal being held open by the speculum, an assistant with his 

 hand upon the crown of the tooth studies the effect of each blow, 

 and notes as it yields to the percussion, and inoves and loosens lontil 

 it becomes detached, and faUs, hberated into his hand, secured 

 l^y his continuous grasp from any possible danger of being swal- 

 lowed. As a riile the tooth is pushed out of its cavity by the first 

 blows, either entu-e or in as many portions as it may have been 

 divided into by the carious process. But at times it becomes 

 necessary to repeat the percussion and to use considerable force 

 to compel it to leave the jaw. 



The modus operandi is about the same for any of the molars, 

 though for the lower teeth greater force in the blows of the mal- 

 let is generally required, in consequence of the greater thickness 

 of the walls of the alveolar cavities in the lower maxillary bone. 

 If it is one of the posterior lower molars which is the subject of 

 the operation, the masseter muscle must be cut thi-ough, but the 

 general manipulations are otherwise the same, care being required, 

 however, to avoid injury to the glosso-facial artery, or the duct of 

 Steno. 



Though apparently a severe ojDeration, this is not a dangerous 

 one, the wounds which it involves healing rajjidly, and the great 

 advantages which are realized by it, among which may be included 

 the cleansing of the sinuses, and the removal of their suppurative 

 collection, which could not be otherwise secured, amply compen- 

 sating for the severity of the process. 



After the operation the wound is, of course, to be thoroughly 

 cleansed, fragments of bone to be removed, and acidvdated gargles 

 used to wash the mouth and the cavity of the alveola of its blood. 



The cicatrization of the external wound generally gives no 

 trouble to the siu'geon, and requires no particular methods be- 



