FllACTURES OF THE FACIAL BONES. 101 



Fractures of the Superior Maxillary Bone are generally 

 caused by blows upon the face with the butt- end of the whip, 

 given by a bad-tempered and savage horseman. As a rule, 

 these fractures are situated anterior to the maxillary spine, and 

 immediately over the superior maxillary sinus, into which the 

 fragments fall. The fracture is usually compound and com- 

 minuted, and is easily diagnosed by the egress of the air 

 expelled by the patient during each time of expiration. 



Treatment. — Eemove all loose portions, bring the edges 

 of the wound together by suture, and apply the collodion 

 dressing. 



The Frontal Bones are broken by falls and other severe 

 accidents; the seat of the fracture is usually found in the 

 orbital process. The anatomist knows that the frontal bones 

 enter into the formation of both cranium and face. If the 

 facial portion be fractured, there is but little danger of imme- 

 diately fatal results ; but if the cranial portion is thus injured, 

 death may be instantaneous, particularly if tlie blow has been 

 sufficient to fracture both plates of the bone. Occasionally, but 

 very rarely, the orbit is pierced by a sharp-pointed instrument, 

 and the orbital plate, which is thinner than any other portion 

 of the cranial bones, is penetrated, and the brain seriously 

 injured. In the most usual form, namely, fracture of the orbital 

 process, it is obvious that many important organs contained 

 within the cavity of the orbit may be seriously hurt, such as 

 the supero-orbital division of the fifth nerve, its accompanying 

 artery, lachrymal glands, and even the eye itself. Sometimes a 

 small piece of the anterior border is, as it were, chipped off, 

 and the tarsal ligament detached from it, which makes the case 

 difficult to manage. 



Professor Yarnell says that " there is a great tendency in 

 this part of the bone, when injured, to ulcerate and crumble 

 away." I have not observed this ; but it may be due to the 

 circumstance that I make it a point in practice never to allow 

 detached fragments of bone to remain in the wound. When 

 the orbital process is completely fractured — say a simple frac- 

 ture from a severe blow with a blunt instrument — the fractured 

 ends are driven inwards by the force of the concussion. In 

 such a case, the eye will be completely closed ; and if there be 

 no swelling or bruise, the closure of the eye is the only symp- 



