Calendar: 1877-1878 Page 633

MEDICAL DEPARTMENT 631 tlie knee stating the circumstances which would determine your choice in case of injury or disease of or near the ankle joint Describe the preparations placed on the table and labelied to II -Case in &urg1 for Commentari boy aged twelve years of somewhat delicate appearance but in good health and well nourished had been observed four years before to have on the right side of his head and face in front of the ear general enlargement which gradually grew without pain until that side was greatly larger than the other When examined the swelling was most evident on the right temple and was moderately firm and elastic on pressure When the teeth were clenched the contraction of the temporal muscle could be plainly felt The arch of the zygoma was seen and felt to be much wider and more prominent than the opposite one while the outer margin of the orbit was pushed forward and inwards Below the zygoma the masseter muscle could be felt when contracting to be pushed outward by an eversion of the ascending ramus of the jaw The movements of the right temporo-maxillary joint were looser and more variable than those of the left On opening the mouth soft and prominent swelling could be felt and seen under the mucous membrane and buccinator muscle in front of the ascending ramus of the jaw and above the orifice of the parotid duct on the right side pressure upon the temple made this swelling more tense and protruding and there was then felt an indistinct fluctuation The molar teeth on this side did not meet when the jaw was closed and the lower mandibular arch was here seen to be placed considerably external to the upper which was flattened and compressed on to the roof of the mouth The patient complained of no pain or tenderness on handling the parts his sight and hearing were perfect and mastication and articulation were fairly performed An opera- tion was performed successfully