SECT. XCII.—ON FRACTURE OF THE LOWER JAW, AND CONTUSION OF THE EAR.
We have treated of contusion of the ear in the [Third Book], as this affection is not of the nature of a fracture. But the lower jaw is fractured from many causes. If, then, it be only fractured externally, and is not divided into two, as it occasions a curvature inwardly, the symptoms of it are obvious. Wherefore, having introduced the index and middle fingers of one hand—of the right, if the right jaw be fractured, and of the left, if it is the left—we push outwards the internal curvature of the fracture, which is to be secured with the other hand externally. The bones of the jaw are ascertained to be set straight by the equality of the teeth. When the jaw is fractured completely across, (that is to say, caulatim,) it is to be set by making extension and counter-extension, with the aid of an assistant; and the teeth, separated at the broken part, are to be fastened together, as Hippocrates says, and bound with gold, namely, with a ligature or thread of gold. But since this is not readily procured by everybody, a strong flaxen thread, a piece of fine linen, horse-hairs, or the like, may be substituted. If the fracture be attended with an external wound, we must examine with a probe and ascertain whether a piece of bone be broken off, and if this be found to be the case, and the wound is small, it is to be enlarged and the broken piece or pieces removed with some suitable instrument, and the lips of the wound united with sutures; then dressings suitable to recent wounds with bandages are to be applied. If there be no wound, a simple cerate is to be applied to the jaw along with suitable bandages. In applying the bandage, the middle of it is to be placed on the occiput, and the fold of it brought along by the ears on both sides to the chin, and then from the chin to the occiput again, and then again to the chin, and thence by the cheeks to the bregma, and then again to below the occiput, where the bandage must terminate. Upon these again a cover, that is to say, another bandage, is to be applied to the forehead and fastened behind the head, in order to secure the aforementioned bandages. Some, also, apply a light splint, or a piece of leather of proper size, to the jaw, and bandage it as we have described. Others use the bandage called a muzzle. If both sides of the jaws are separated at the symphysis, having removed them a little asunder with both the hands, adapt them again to one another, and having fastened the teeth together as aforesaid with a ligature, and applied the proper bandages, order the patient to be nourished with thin soups, because mastication is hurtful in this case. And, if you suspect that it has been deranged from its position, loose the bandages on the third day, and apply them again, and do in like manner until the callus be formed. The callus of the jaw-bone is generally formed within three weeks at most, because it is spongy and full of marrow. If any inflammation come on, we must not neglect the embrocations and cataplasms suitable to it; which practice is to be observed in all cases.
Commentary. Our author’s account of fractures of the lower jaw is taken almost word for word from Hippocrates. (De Articulis.) He divides them into external fractures, and fractures caulatim (or cauledon), which, agreeably to the explanation of this term, given in [the 89th section], Galen interprets to be a complete separation of the fractured portions. He directs us to fasten the teeth with a gold thread; and in other respects also his practice is exactly the same as our author’s. His account of fracture at the symphysis is very correct.
Soranus gives a very sensible account of this subject. A transverse fracture, he says, often takes place, but a longitudinal one seldom, and in certain cases it is not attended with any distortion. It is to be recognized by examination with the fingers, when any displacement of the parts and crepitus will be recognized. Fracture in the ramus may be distinguished from dislocation, by there being mobility in the former case, whereas there is none in the latter. (Chirurg. Vet. p. 49.)
Celsus says, that in fractures of the jaw-bone the separated portions are never completely disjoined. When the bone is fairly broken transverse, the tooth at the fractured part protrudes, and is therefore to be secured to the adjoining one with a hair. He then recommends us to apply a double compress, moistened in wine and oil, with agglutinants; and afterwards a bandage or soft piece of leather is to be put on with its middle at the chin, and its extremities fastened above the head. In this, as in every other species of fracture, he recommends at first abstinence, and afterwards, liquid food; not allowing a full diet until the inflammation has subsided. He says, a fractured jaw-bone gets consolidated between the 14th and the 21st day.
Albucasis evidently copies from our author; and Avicenna and Rhases do so avowedly.
Haly Abbas gives a similar account, recommending us to secure the teeth with a thread; and then to apply bandages, and occasionally a compress, as directed by our author.
By the first variety, described by all the ancient authorities, was meant, we suppose, a fracture of the condyle.