A system of oral surgery : being a treatise on the diseases and surgery of the mouth, jaws, face, teeth, and associate parts

Front matter

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Preface To The Fourth Edition

In presenting the fourth edition of this work to a professional public, the ‘author desires to acknowledge the encouragement and stimulation derived from the continued generous reception and the constantly-increasing sale. The present book is enlarged by addition of several chapters on subjects not heretofore embraced. LExertion has been increased to condense and simplify. Illustrations to the extent of seventy-five new cuts have been added. Every part of the volume has been rearranged, rewritten, or complemented.

The fact that this ‘‘ system” has come into common use by dental colleges makes desirable unexceptionable fulness in the direction of things considered by the specialty. Effort has been made to have no principle absent. Irrelevant matter is not present to perplex.

The teachings and demonstrations being prepared specially for the guidance of students and practitioners of oral surgery, the author offers them as a result of thirty years of practice. Time has been taken for experimentation,

for consideration, and for execution. The responsibility has been continuously ‘in mind. The writer has done all he finds himself able to do.

It is desired to express special obligation to Professor D. Hayes Agnew and Dr. James W. White for the free use of costly diagrams, and to the publishers for the courteous attention and care shown while the work was passing through the press.

J. E. G.

~ iv

Preface To The Fifth Edition

THE interim between the present and the immediately preceding edition of this book has been occupied in a continuation of work by its author with view to enlarging and elaborating experiences that might prove of benefit to his patients, his students, and himself. An observer, in looking over the volume in hand, and comparing it, even with the last of former issues, will find continued increase in the way of new chapters, together with many added illustrations, while alterations and interpolations will meet his eye on almost every page. This new matter and manner replace in no sense the old, for the writer, happily, is without occasion to change any opinion or judgment that has been advanced. The meaning of the additions lies with the rapid growth and advance of the specialty. As to change of manner to be seen, this is with view to a still further condensation of the matter of the book and to such elaboration in way of presentation of the subjects treated in it as shall make them easier of comprehension by a student, and, if possible, more practical.

Oral surgery, twenty years back, was without so much as a name. To-day, oral surgery, as a specialty in medicine, is not surpassed, as to its range and as to requirements looked for on the part of its practitioners, by any department of the healing art. It has become what it is by reason of the need for its existence.

As expounded in the present work, and as the specialty might not otherwise have existence, oral surgery includes dentistry ; it includes it in a purely surgical sense, thus assuming dentistry to be, not a profession in itself, but part of medicine at large; such assumption being founded on an experience which clearly enough exhibits that where medical knowledge is lacking dentistry is of very little use to a community.

What oral surgery is, and what dentistry is when practised from the stand-point of oral surgery, it is left to the volume to show.

The author is under large and continued obligations to Professor D. Hayes Agnew and to Dr. James W. White, whose generosity has contributed largely vii viii PREFACE TO THE FIFTH EDITION.

to the free illustration of his work. He is also indebted to Professor J. M. Da Costa for loan of cuts. The legends of the anatomical illustrations are mostly from the invaluable work of Professor Joseph Leidy. Dr. Formad, Pathologist to the University of Pennsylvania, has freely contributed of his skill in the way of microscopic drawings. Certain of the cuts that appear in the section on Harelip, from Ashhurst’s “System of Surgery,” have been kindly loaned by the Messrs. Lea. Also indebtedness is to be expressed to them for use of some half-dozen of the diagrams employed in illustrating the pages treating of Partial Dentures. The surgical instrument makers of his city have been profuse in their offers of illustrative help, and it is a pleasure to mention especially the names of Kolbe, Gemrig, and Lentz. As to his publishers, the J. B. Lippincott Company, the work itself shows them to have spared neither time nor expense in its production ; they have denied its author nothing.

THE AUTHOR.

1537 Cuestnor Street, PHILADELPHIA, 1890.

Contents

: CHAPTER I.

DESCRIPTIVE AND SURGICAL ANATOMY OF THE HEAD.

PAGE

Chapter II. The Muscles Of Expression And Mastication

Fronto-palpebral, Nasal, and Oral Groups of Muscles—Relations and Actions of Muscles of Expression—Blood-vessels, Nerves, and Lymphatics of Muscles—Description of Individual Muscles—Muscles of Mastication . . ‘ - : . . - 69

Chapter III. Arteries And Veins Of Facial Region

The Heart—General View of Head Circulation—Arterial Circulation of Facial Regions —Primitive Carotid Arteries—External Carotid Arteries and Branches—Internal Maxillary Arteries and Branches—Internal Carotid Arteries and Branches—Circle of Willis—Analysis of Venous Circulation of Head and Neck—Vena Cava Superior— Jugular Veins, External and Internal—Formative Branches of Jugular Veins— Internal Maxillary Vein—Sinuses of the Dura Mater—Temporo-maxillary Vein and Tributaries . “ ‘ , . : : : . . . . . . - 80

Chapter IV. Lymphatic Vessels And Glands Of The Head

Office of —Lymph—Vessels—Glands—Glands and Vessels of Cranium—Superficial of Face—Deep of Face—Superficial of Neck—Regions and Number of Glands. - 99

Chapter V. The Facial Nerve

Diagram of Distribution—Anatomy of Origin—Nerves of Communication—Nerves of Distribution . . F ‘ . . ‘ . : . “ : . . 103 x CONTENTS.

Chapter VI. Fifth Pair Of Nerves

Diagram of Distribution—Diagram of Origin—Character of Nerve—Ganglion of Gasser —Ophthalmic Branch—Primary Division and Ultimate Distribution of Ophthalmic Branch—Superior Maxillary Branch—Relation with Meckel’s Ganglion—Supply of Teeth—Branches all Sensory—Primary Division and Ultimate Distribution—Inferior Maxillary Branch—Compound Character of—Supply of Muscles of Mastication— Gustatory Nerve—Supply of Inferior Teeth—Primary Division and Ultimate Distribution—Ganglia and Functions of Fifth Nerve. :

Chapter VII. The Mouth

Boundaries of Oral Cavity—Vestibule—Lips and Cheeks—Mucous Membrane—Mucous Glands—Frena—Sectional Dissection of Mouth—The Tonsil Glands—The Tongue—The Epiglottis—The Salivary Glands—The Temporo-maxillary Articulation . . . . : . : : :

Chapter VIII. Anatomy Of The Teeth

A Tooth a Body sui generis—Dissection of a Tooth—The Pulp—The Dentine—The Enamel—The Cementum—The Periodonteum—The Interglobular Spaces—Relation of Teeth with Jaw—The First and Second Sets of Teeth—Classification of Teeth— Descriptions of Teeth—Analysis of Dentine—Analysis of Enamel—Analysis of Cementum . ‘ . ‘ . é ‘ : ‘

Chapter IX. Dentition

Origin and Meaning of the Term—Origin of the Teeth—The Dental Germ—Tunica Propria—Tunica Reflexa—Formation of Dentine—Formation of Enamel—Growth of Roots of Teeth—Nutrition of Teeth—Involution of Epithelium—Clinical Consideration of Dentition—Order of Eruption of Temporary Teeth—Germs of Permanent Teeth—Antagonism of Permanent and Deciduous Teeth—Absorbed Deciduous Roots—Arrangement of Teeth—Articulation of Teeth . ‘

Chapter X. Associative Lesions Of First Dentition

Fatality associated with the Period—Irritation—Diseases associated with Dentition—Stomatitis—Irritative Fever—Diarrhcea—Spasms—Eruptions on Skin of Scalp and Face—Lancing the Gum—Hemorrhage in Lancing—Cachexia—Tickling and Rawness of Throat—Chronic Angina—Spasm defined . . : .

Chapter XI. Anomalies Of Second Dentition And Their Surgical Relations

Teeth Eruption, External or Internal to the Arch—Teeth denied Space in the Arch— Encysted Germs—Supernumerary Teeth—Third Dentition—Periodonteal and Periosteal Associations—Germs with Heterogeneous Development—lllustrations . .

PAGE

CONTENTS.

Chapter XII. The Teeth And Their Diseases

Caries—Health in the Dental Organism—Causes Provocative of Caries—Serofulosis—- Rickets—Shapes of the Teeth—Nutritional Cireumstances—Relation of Organs with each other—Self-cleansing Features—Constitutional Relations—Character of Agents in Contact with the Teeth—Mucous Deposits—Acid Secretions—Parasites—Electro-chemical Relations—Medicines and Articles of Food—Accidental Influences

Chapter XIII. Surgical Consideration Of Dental Caries

Phenomenal Expressions of Caries—Principles of Treatment—Neutralization of Adverse Oral Fluids and the Induction of a State of General Health in the Mouth— Medical Treatment of the Teeth—Characteristics of Saliva—Teeth of Sanguine and Allied Temperaments—Teeth having a Blue Shade—Chalky Teeth—Pearly Teeth— Soft Dentine—Zine Chloride—Filing as a Prophylactic and Curative Agent—Vitrifaction—Inclined Surfaces—Illustrations in Filing . ‘ - . ; ‘

Chapter XIV. Dental Therapeusis

Inertness of Gold as a Filling Material—Therapeutical Plugs—Recalcification of Teeth—Oxychloride of Zine—Gutta-Percha—Copper Dust—Oxide of Tin—Electrical Disturbance—Parasiticides—Creasote—Corrosive Sublimate . -.

Chapter XV. The Oral Fluids

Saliva—Composition of; Characteristics of—Mucous Oral Detritus—Analyses of Oral Fluids—Saliva unduly Alkaline—Healthy Saliva—Parotid Secretion—Submaxillary Secretion—Accessory Parotid Secretion—Saliva and Food Bolus—-Saliva unduly Acid—To make Analysis of Saliva—Abnormal Saliva—Accidental Substances found in Saliva—Carbolic Acid and Saliva—Magitot’s Experiments with Acids and Teeth—Sordes—Excess of Ptyaline—Acids of Fruits in Relation with Soft Teeth

Chapter XVI. The Teeth And Their Diseases

ODONTALGIA.

Causes of Toothache—Sensitive Dentine—Exposure of Pulp—Disease of Periodonteum—Pus and Gas in the Pulp-Cavity—Granules of Osteo-dentine in a Pulp— Sympathetic Toothache—Recession and Absorption of Gum and Alveolus .

Chapter XVII. The Teeth And Their Diseases

PERIODONTITIS.

Synonymes—<Acute Periodontitis—Chronic Periodontitis—Case of Ringed Root— Treatment of Periodontitis é é . , ‘ ‘ ‘ xi

PAGE xii CONTENTS.

Chapter XVIII. The Teeth And Their Diseases, Alveolo-dental Abscess

History and Meaning of—Local Features of—Prophylaxis of—Abortive Treatment of— Anomalous Cases of—Discoloration of Dead Teeth—Abscess venting upon Cheek— Abscess associated with Wisdom-Teeth—Abscess and Maxillary Sinus—Osseous Cysts and Abscess—The Nares and Alveolo-dental Abscess—The Wisdom-Teeth and Alveolo-dental Abscess—The Duct of Steno and Abscess—Discharge of Abscess through Dental Foramen—False Abscess—Chronie Abscess—Rheumatic Diathesis—Gout in Abscess—Discharge of Pus—Abscess discharging through Pulp-Canal—Counter- Outlet—Improper Canal Filling as Cause of Abscess—Malarticulation—Abscess associated with Temporary Teeth—Imprisoned Teeth—Protoplasmic Degeneration— General Indications . “. . , P ‘ ‘ P ; , : a

Chapter XIX. The Teeth And Their Diseases

THE PULP-CHAMBER AND CANALS.

Death of Pulp—Removal of, from Cavity—Multiple-rooted Teeth—lIndications following Removal of a Dead Pulp—Littlejohn’s Flexible-shafted Bur—A Temporary Canal Filling—Retention of Test Filling—Continuous Irritability—Causes of—Permanency of Quiet—Gold in Root Filling—Cotton and Gold conjoined as a Canal Filling—Gold forced beyond Foramen—Enlarging a Canal—The Broach—Conduetion and Non-conduction—Rest—Filling over Exposed Pulps—Illustration—Thin Plate of Dentine—Oxychloride of Zine as a Pulp Capping—Oxychloride of Zine as an Intermediate—Pain as Result of Capping Application—Quill as a Capping— Oiled Silk as a Capping—Oxysulphate of Zinc—Various Preparations used for Capping—Orifices with Jagged Edges : . . . . . . . .

Chapter XX. Discolored Teeth

Impossible to restore Translucency in a Dead Tooth—Checking advancing Discolora-— tion—Bleaching—Removal of a Bleaching Agent—Zine used in Place of Lime— Bleachers—Chlorate of Potassium as a Bleacher—Labarraque’s Solution—Immediate Bleaching—Whitening—Manners of Whitening—Hematin as a Discolorer—Dead Pulp as a Discolorer—Whitening rather than Bleaching . : . : : :

Chapter XXI. Replantation, Transplantation, And Implantation Of Teeth

Definition of Terms—Initiative Performance—Replantation—Mistakes in Extraction —Dental Abscess—Treatment of a Tooth to be replanted—Treatment of the Socket to be occupied—Relation of an Extracted Tooth and Cavity—Closing an Outlet— Artificial Fistule—Drain-Tubes—Gold Apices—Transplantation of Brutes’ Teeth into Human Sockets—Report of Cases—Length of Time a Tooth may remain unused— Advantage lying with Root-Canals filled after Extraction—Tooth replanted in Restitution—Tooth transplanted by Transposition—Implantation an Unsurgical Procedure—Method of -Practice—Preliminary Treatment of Tooth—Preparing the Cavity—Exposing the Bone—Removing Periosteum—To cut Cavity in Bone—Objection to Trephine—Reamer Blades—Ottolengui’s Bur—Spiral Knives—Younger’s Reamers—Anatomy of the Maxilla—Dental Canal—Implanted Teeth as Posts for Bridge-Work—Theories concerning Reunion—Absorption of Planted Roots—Illustrations from Practice of Dr. Weld. . A . . . 4 . : .

PAGE

CONTENTS.

Chapter XXII. Denudation

Common Seat of the Disease—Diversity of Opinion concerning Cause—Electro-chemical Experiments of Kencely Bridgman—Abrasion of Cutting Faces—Caused by Malarticulation—Influence of Food—Treatment .

Chapter XXIII. Operative Dentistry

INSTRUMENTS USED IN PREPARATION OF CAVITIES.

Illustration of a Perfect Denture—Imperfect Denture—Size, Shape and Location of Cavities—Excavators—Drills, Rose and Spear—Merry’s Drill—Bur Thimble—Dental Engine — White’s and Bonwill’s Engines — Chisels—Jack’s Double-end Enamel Chisels—Files—File-Carriers—Miller’s File-Carrier—Forbes’s File-Carrier—Line’s File-Carrier—Saws used for separating Teeth—Clapp’s and Kaeber’s Saw-Carriers —Corundum Disks—Objects of Saws and Corundum Disks—Other Means of separating Teeth—Drop-Tubes—Herrick’s Fountain Drip-Point—Chip-Blower—Water- Syringes—Exposure of Cavities—Wedges—Anagnostakis’s Ophthalmoscopic Glass .