Ulysse Trélat was a prominent French surgeon of the nineteenth century. He served as surgeon-in-chief to most of the major hospitals of Paris, published important textbooks and received the highest honour the French state can bestow, the Légion d’Honneur. His name still appears today in medical dictionaries as the co-inventor of an operation to treat cleft palate, and for the Leser-Trélat sign, a possible indicator of undetected malignancy.
This case was published in 1877 in Clinique chirurgicale des hôpitaux de Paris, a collection of case reports drawn from the surgical wards of the French capital. The editor notes that this surprising case underlines the fact that ‘the surgeon must always expect the most implausible discoveries.’ He’s not wrong:
A healthy-looking young man arrived at the Charité, saying that he had a painful mouth and complaining, unusually, of a tingling in the back of the throat and a little discomfort while swallowing.
The young man explained that a little more than a year earlier he had been stabbed on the left side of the face; but the wound had healed so quickly that he was able to attend the trial of his assailants shortly afterwards.
Two clearly visible scars appeared to confirm the patient’s story: one lying outside the left external orbital process, the other located on the outside of the masseter; the jaw could be opened only with some difficulty.
The masseter is the large and powerful muscle principally responsible for chewing. These wounds had been inflicted to the man’s cheek.
M. Trelat found it easy to introduce a wooden retractor into the vestibule of the mouth, and used this instrument to examine the inside of the cheeks and the alveolar arches.
The ‘vestibule’ of the mouth is the area between the lips and the teeth; the alveolar arches are the ridges of bone beneath the gums. Behind the last lower molar on the left side, M. Trélat noticed a jagged surface protruding from a lump in the gum.
Using a metal probe to explore this further, the surgeon felt a hard, flat body. Shortly afterwards, with the help of forceps, he was able to extract a knife blade, 6 cm long and 3 cm wide, which was lodged in the region of the tonsils; and which, in spite of its enormous dimensions, had not caused any serious effects in this young man.
A knife blade 6 cm by 3 cm (2.4 by 1.2 inches) is a serious piece of metalwork to have buried in your jaw for more than a year – particularly in the absence of infection or other significant complications. An ‘implausible discovery’ indeed.