Friday, September 18, 2015

Asian child's jaw becomes necrotic, falls off (a case from 1938)

Imagine suffering for months from a purulent, festering infection in your mouth; imagine it going deeper and deeper into the tissues, eating away at your lower jaw as you burn with fever, until the entire mandible breaks off from the skull, a hunk of blackened, dead bone...

Sounds like something from a Stephen King novel, right? Well, this horrid scenario unfortunately occurred in real life, nearly 80 years ago, and the hapless victim was a 6-year-old male child from the island of Formosa (known today as Taiwan). The boy came from a family of poor villagers, and his dental troubles started with a simple toothache. The case was recounted in detail in the Canadian Medical Association Journal in 1939 by one J. L. Little, M. D.

"G.B.P., a Formosan child, aged 6, was presented at the clinic with a complaint of a swollen face and a foul, necrotic piece of bone lying in the floor of the mouth. Four months previously the child had suffered from toothache and a small "gum-boil" at the site of the second right lower molar tooth. After an extraction of this tooth inflammation advanced rapidly until the mouth could scarcely be opened and the right eye was closed. After three days of suffering the swelling began to invade the left jaw as well and it was decided to move him from his home village into the nearest municipal hospital. There an external incision over the right ramus was made to provide drainage, and a quantity of foul pus was evacuated. The father reported that during the ensuing weeks the mouth was very putrid, the gums swollen and spongy, while the teeth seemed to rise up out of the festering tissue. The child ran a high fever, became waxen in colour, and was delirious every evening. He removed many of his loose teeth with his fingers. After a month's treatment with daily irrigation the patient was sent back to the village herbalist in despair of recovery. Slowly the alveolar sockets emerged from the soft tissues, while the upper teeth became disfigured with a dense black film but were otherwise unaffected. 

The child was admitted on September 27, 1938, with the tongue pushed up against the palate by a black, jagged, bony mass which moved slightly on pressure, but scarcely any pain was elicited. On the prominent right cheek was a sinus which was discharging thin, serous matter, and through which dead bone could be felt with a probe. At this time the child was afebrile and in quite good health. [...] It was decided that the best course of action would be to divide the mandible in the midline and extract the two halves through the mouth.

Under ether-chloroform anaesthesia it was found that the heads of both wings of the mandible could be moved quite readily and it became evident that the mouth would deliver the entire sequestrum without injury to the adjacent tissues. Under gentle pressure and with practically no bleeding the jaw was detached and withdrawn intact."

The boy was able to enjoy a soft diet immediately after the operation, and began to play about the ward three days later. He was discharged from hospital on October 7, 1938. The author blithely concludes:

"It is unlikely that this particular child will ever receive any further attention to his dental needs because of his poverty, but he will undoubtedly be able to handle the rice diet of the Formosan farmer without great inconvenience."

One can't help wondering how long this child lived afterwards, what quality of life he had, and whether he survived World War II.


Little JL. (1939) Sequestration of the entire mandible. Can Med Assoc J. 40(5): 481–482.


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