Thursday, June 9, 2011

Apollonius of Kition and the dislocated jaw

Apollonius  was considered to be the most important of all Cypriot physicians of his time.He lived in 60B.C in the city  of  Kitio, modern  Larnaca...He had studied medicine in Alexandria under the surgeon Zopyrus and belonged to the empiric school of thought.
The fame of Apollonios was spread all over the ancient Greek  world. The medical opinions of Apollonios were considered valid and authentic according to Herodian . Important personalities such as\Strabon, Cicero and Dioscorides have also written positive comments on Apollonios. Although primarily a physician, Apollonios had an interest in surgery and trauma.
Apollonios wrote several books on medicine  but his most important (and the one that survived) is Peri Arthron (On Joints, ) which is a study of the teachings of Hippocrates on the subject. This book was written in Cyprus.
 A copy of this work was found in the library of the Byzantine doctor Nikitas, and it is now kept in Florence.
The book was written under the patronage of the king Ptolemaius of Cyprus c. 81-58 BC. It is divided into three sections written at different times. The first part discusses the dislocations of the shoulder; the second discusses those of the elbow, wrist, jaw and spine, whereas the third and final part discusses the dislocations of the lower limbs. The book includes 30 hand-painted pictures, believed to be copies made from the original book written by Hippocrates himself.
The illustration of the ninth-century Byzantine copy which is now kept in Biblioteca Medica Laurenziana in Florence shows the recommented method of reducing a dislocation of the lower jaw.

A dislocated jaw (dislocated mandible) generally is very painful. The mouth cannot be closed, and the jaw may be twisted to one side. A dislocated jaw is typically caused by the following:
  • Opening the mouth excessively wide (such as with yawning, vomiting, or during a prolonged dental procedure)
  • An injury

Dislocation is more likely to occur in people who have had previous dislocations or who have looseness of the jaw (hypermobility), which may result from a temporomandibular disorder.
A doctor or dentist typically maneuvers the jaw back into place by hand (manual reduction).
After wrapping their fingers with gauze, doctors or dentists place their thumbs inside the mouth on the lower back teeth. They place their other fingers around the bottom of the lower jaw. They press down on the back teeth and push the chin up until the jawbone returns to its normal location.

Once the jaw is back in place, people are cautioned to avoid opening the mouth wide for at least 6 weeks. For those who have had more than one dislocation, surgery may be needed to reduce the risk of further dislocations. For instance, the ligaments connecting the jaw to the skull (at the temporomandibular joint) can be shortened, thereby tightening the joint.

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