NOTES ON ODONTOMES. 
87 
opening was made directly over the affected pre-molar about one 
inch from the alveolar border and from this opening the exter¬ 
nal alveolar wall was cut away down to the margin, thus lay¬ 
ing bare the body of the tooth for its entire length. A punch 
was placed against the tooth and a few sharp blows dealt with a 
mallet, which so loosened the member that it was readily grasped 
by the crown and removed entire, tumor and all, through the 
opening in the cheek, leaving behind an immense opening from 
the mouth into the nasal chamber. 
The patient succumbed 48 hours later from gangrenous 
pneumonia due to inhalation of putrid food, which had fallen 
into the fauces through the posterior nares, the inhalation being 
in all probability due to the dyspnoea provoked by the long 
journey prior to operating. While operating the head was 
slightly depressed, which, in addition to tracheotomy, should 
have sufficed to prevent inhalation during the operation. Never¬ 
theless, while operating, decayed food in very small amount 
escaped through the tracheotomy tube, but apparently from be¬ 
low. The precaution was taken after the operation to thoroughly 
irrigate the trachea and bronchi with normal salt solution and 
hydrogen peroxide, which irrigation was repeated after 24 
hours. 
The tabular surface (C) of the tooth (Fig. I) is not unlike 
the ordinary wearing surface of a premolar, except it is appar¬ 
ently composed entirely of a rather soft dentine, while higher 
up toward the anterior portion of the body on the median side 
there appear some fragments of enamel (D). The dental tis¬ 
sues proper extend from C upward to a point midway between 
D and A. The remainder of the mass anterior to D and supe¬ 
rior to the line above mentioned consists of fibroid tissue gener¬ 
ally free from adhesions to surrounding parts and directly 
continuous with the dental tissues. The free end (B) is smooth 
and globular. At A, showing as a slight depression containing 
a small rounded mass, is a small islet of hard dental tissue, ap¬ 
parently dentine. At P is dentine, which by necrotic erosion 
had caused an opening through the bony palate by which food 
