336 DISEASES OF THE HOESE. 



be dispensed with. In the complete variety the danger to be com- 

 bated is compression of the brain, and attention to this indication 

 must not be delayed. The means to be employed are the trephining 

 of the skull over the seat of the fracture and the elevation of the de- 

 pressed bone or the removal of the portion which is causing the 

 trouble. Fragments of bone in comminuted cases, bony exfoliations, 

 collections of fluid, or even protruding portions of the brain sub- 

 stance must be carefully cleansed away and a simple bandage so ap- 

 plied as to facilitate the application of subsequent dressings. 



FRACTUKES OF THE BONES OF THE FACE. 



In respect to their origin — usually traumatic — ^these injuries rank 

 with the preceding, and are commonly of the incomplete variety. 

 They may easily be overlooked, and may even sometimes escape rec- 

 ognition until the reparative process has been well established and the 

 wound is discovered owing to the prominence caused by the presence 

 of the provisional callus which marks its cure. When the fracture is 

 complete it will be marked by local deformity, mobility of the frag- 

 ments, and crepitation. Nasal hemorrhage, roaring, frequent sneez- 

 ing, loosening or loss of teeth, difficulty of mastication, and inflamma- 

 tion of the cavities of the sinuses are varying complications of these 

 accidents. The object of the treatment should be the restoration of 

 the depressed bones as nearly as possible to their normal position and 

 their retention in place by protecting splints, which should cover the 

 entire facial region. Special precautions should be observed to pre- 

 vent the patient from disturbing the dressing by rubbing his head 

 against surrounding objects, such as the stall, manger, rack, etc. Clots 

 of blood in the nasal passages must be washed out, collections of pus 

 removed from the sinuses, and, if the teeth are loosened and liable to 

 fall out, they should be removed. If roaring is threatened, trache- 

 otomy is indicated. 



FRACTURES OF THE PREMAXILLARY BONE. 



These are mentioned by continental authors and are usually en- 

 countered in connection with fractures of the nasal bone, and may 

 take place either in the width or the length of the bone. 



The deformity of the upper lip, which is drawn sidewise in this 

 lesion, renders it easy of diagnosis. The abnormal mobility and the 

 crepitation, with the pain manifested by the patient when under- 

 going examination, are concurrent symptoms. Looseness of the 

 teeth, abundant salivation, and entire inability to grasp the feed 

 complete the symptomatology of these accidents. In the treatment 

 splints of gutta-percha or leather are sometimes used, but they are 

 of difficult application. Our own judgment and practice are in 

 favor of the union of the bones bv means of metallic sutures. 



