Fig. 248.—Diffuse Syphilitic Disease of Mandible.
Actinomycosis.—This condition is met with in the jaws more frequently than in any other part, and the mandible is attacked oftener than the maxilla. The actinomyces gain access to the bone through a carious tooth or through the gum.
At the outset the patient complains of pain and tenderness referred to one or more carious teeth. Within a few weeks a swelling forms—in the mandible near the angle as a rule, and in the maxilla in some part of the cheek. The swelling, which varies in consistence, implicates the bone and cannot be moved apart from it. The skin over it becomes red, suppuration occurs, and sinuses form and give exit to a sero-purulent fluid in which the characteristic yellow “sulphur grains” may be detected. The surrounding soft tissues are infiltrated, and the part becomes riddled with sinuses, which lead down to bare bone. The disease usually runs a chronic course, lasting for one or two years, and, unless pyogenic infection is superadded, is not attended with fever.
In the absence of the characteristic yellow granules, actinomycosis may readily be mistaken for tuberculous or syphilitic disease, or for sarcoma.
The treatment consists in removing the diseased tissue with the knife or sharp spoon, and in the administration of large doses of potassium iodide. The insertion of tubes of radium has a beneficial effect.
Tumours of the Alveolar Process.—Epulis.—The tumours that grow from the alveolar processes of the jaws appear at first sight to spring from the gums, hence the term epulis, generally applied to them. They really originate in the periosteum of the alveolus or in the periodontal membrane, and are essentially of the nature of fibro-sarcoma. In some, the fibrous element predominates, but the frequency with which they recur after removal, unless the segment of bone from which they spring is also excised, indicates their malignant tendency. In most cases the tumour is of the myeloid type—myeloma; in others new bone is formed in its substance—osteo-sarcoma.
An epulis usually begins in the gap between two teeth, and grows slowly, either towards the cavity of the mouth, or more frequently towards the lip or cheek, where it appears as a bright red, smooth, firm, rounded swelling, which is adherent to the jaw, and may be sessile or pedunculated ([Fig. 249]). It causes little pain, but is liable to interfere with mastication. As it increases in size it spreads over the alveoli of several teeth, becomes softer, and assumes a dark violet colour, and if subjected to pressure or irritation may ulcerate and bleed.
Fig. 249.—Epulis of Mandible.
(Anatomical Museum, University of Edinburgh.)