A Case of Permanent Closure of the Jaw Resulting from Infantile Paralysis
Authors: W. E. Meads
Journal: BMJ (1904)

ON JUlY 12th, I903, I was consulted dentally by a patient, Miss E. B., aged 28, to know if I could do anything to relieve her acute toothache.Upon examination, I found the case was one of permanently locked jaws, and the following is the bistory and particulars of the case:Hi8tory.-The patient gave me the following history of her case.When about Is months old she had a severe attack of whooping-cough, and during convalescence she was given a hot bath.This was followed by two fits in quick succession, a,nd she was taken to St. Mary's Hos- pital, Paddington, where it was found sbe had considerable paralysis upon the right side, affecting the lower jaw and the right leg.She re- mained at that hospital about eighteen months and the lower jaw be- came firmly closed.From that time to the present the patient had tever opened her mouth.The patient had at various times been to s everal hospitals and seen many medical men.Besides St. Mary's Paddington, she had attended as an out-patient at The Children's Hos- pital, Great Ormond Street, Paddington Green Hospital, St. George's,St. Thomas's, and the Middlesex.She had also attended the West London Hospital, Hammersmith, for two months in each of three consecutive years.Last time she went there she was told that nothing more could be done except a general operation (I presume from the patient's re- marks either excision of the condyle or Esmarch's operation was con- templated).Other medical men had confirmed this opinion.At one hospital they made seven attempts under chloroform presumably to break down adhesions surmised to exist at the articulation of the mandible.The patient had during these years eaten most usual foods, cut up finely, and with pepsinogen; and for years she had fed herself by pushing the food up between the upper and lower incisors (the lormer I conclude being somewhat anteriorly pretruded), and had down her finger nails in the process.Some five years before I saw the case a dentist had operated under gas, andhad broken off the crowns of three uppei and three lower incisors, leaving the roots still in.Through the aperture thus gained the patient had since fed herself with more ease and comfort.State on Examination.-Thepatient, small and somewhat fragile in appearance, but otherwise apparently healthy,had her lower jaw almost immovably fixed, with the lower teeth in close contact with the upper teeth.The patient possessed a complete set of permanent teeth, which were interlocked and the jaw firmly fixed.On the right side the whole of the upper and lower teeth and the outer gums were covered by shield-like mass of tartar, which the patient imagined was some bony development on her jaw.Most of the teeth were more or less arious, and theimmediate cause of the patient coming to me was pain in or about the second uipper right molar.The whole mouth wasin dmost sentic condition, with muich tartar, spongy gums, and some pus exudation, while the breath of the patient was so offensive that it was becoming more and more detrimental to her in her business-that of a lady's hair-dresser and wig-maker.The patient had the crowns of three upper and three lower incisors missing, but the roots were still remaining.These were the roots left in from the operation referred to above.The patienthad no temporary teeth or roots remaining, though how these were disposed of I could not ascertain.The patient informediime that'her temporary teeth ,quite close together, though she thought not so locked as the permanent teeth.She had never had any temporary teeth extracted.There was no trismus of the muscles.and the jaw could be moved to the smallest possible extent by the patient.This movement was at the most not more than1 in.between the front teeth, and, though this was perceptible, for all practical purposes the lower jaw was immovably fixed.This slight movement, however, seemed to indicate that the muscles were not in a state of trismus or tensioni, and also that the fixture of the jaw was not due to ossificatioii of the mandibular condyle.Beyond this very slight movement referred to no further move- ment of the mandible could be obtained by passive manipulation.Owing to the mandible never having been used it presented remarkable example of non-development from non-use.The mandible was narrow, thin, and apparently, fragile, the horizontal ramus passing almost imperceptibly into the ascendlng ramus without the develop- ment of much angle.Neither was the general contour of the chin developed, there being practically no chin apparent, but passing from the neck to the face gradually.Both these abnormalities were more conspicuious on the right-the paralysed-