On cleft palate : with cases in illustration of its successful treatment / by George Frederick Lane.
- Lane, George F. (George Frederick), 1828?-1856.
- Date:
- [1851]
Licence: Public Domain Mark
Credit: On cleft palate : with cases in illustration of its successful treatment / by George Frederick Lane. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![great that no apprehension need bo en- tertained that the incisions which have boon recommended will not heal ra- pidly, provided the health of the indi- vidual is not sufiering from any other cause, and in such a case the operation should be deferred. Since the foregoing paper was com- municated to the Abernethian Society of St. Bartholomew’s Hospital, four other cases have come under my observation, occurring in the practice of Mr. Gay, tlii’ec of which are at the present time in the Iloyal Free Hospital. Case II.—Eliza Smith, aged 23, was admitted into the hospital Oct. 14 of the present year, having come from Ewell, near Hover. This patient had ])reviously undergone an operation, and has been alluded to before. On examination, a fissure was seen extending through the velum, and slightly implicating the hard palate. The halves of tlie palate were perfectly sound, nearly nine months having elapsed since the former operation was performed; and tiie tissues did not ap- pear to have undergone much change by having been already operated upon. Her general health was good; and, in order that she might be in a favourable condition in this respect, the operation was performed at once. Accordingly, on the Itith, the weather being fine, Mr. Gay proceeded to operate in the pre- sence of Messrs. Avery, Dempsey, Jack- son, and Davenport. The levator ]ialati of each side was fii-st divided, afterwards the posteiior pillar of the fauces, and then, to a slight extent, the anterior jiillar of one side. By section of these muscles the palatal movements were tolerably controlled, and the flaps were rendered loose. The edges of the cleft were now freely pared, aud the soft pai'ts detached from the under surface of the hard j>alate for about tliree or four lines forwards on each side. The edges were brought together by four sutures, tlie parts about the anterior suture being rather tense. After division of the levator palati some relaxation of the j>arts took place, but it was most considerable after tlie palato-phaiyngei were divided. A little bleeding occun-ed, but was readily arrested by iced water. The operation occupied nearly three-quarters or an hour. The patient was after- wards kept in bed and not allowed to speak. Nourishing fluids were given in small quantities and often, the fluid being carried to the hack part of the pharynx in a spoon. On the 19th slight sujipuration had commenced; the edges ot the flaps had remained in close contact, except in front of the anterior stitch; she com- plained of smarting pain and the dis- agreeable odour arising from the palate; there was no undue inflammation of the parts or constitutional disturbance. 2ist. — Posterior suture removed; parts keep in good apposition. 22d.—Next suture removed. 23d.—The two remaining sutures taken out. 24th. — She has commenced eating solid food : a small quantity of matter exudes from the unclosed part, which is immediately behind the hard palate, aud about the size of a quill; the rest of the palate remains united. 31st.—The part which was found not to have united is gradually closing without any application. Nov. 20th.—The opening will but admit a probe, and is healing up. Case III.—Mary Bryan, set. 21 yeai-s. This patient originally had a fissure of both hard and soft palate, extending through the alveolar margin, and com- plicated with hare-lip and considerable projection forwaj-ds of that portion of the upper jaw bearing the front teeth. Mr. Gay operated on the hare lip several months ago; and the patient was ad- mitted, Oct. 8th, for the purpose of at- tempting to remedy the defect in the bony structures, preparatory to uniting tlie cleft in the soft palate. It was ob- served that, as usual, the fissure in the hard palate was to the left of the mesial line, leaving the septum nasi attached inferiorly to the right mai-gin of tlio cleft. The projecting portions of alve- olar border were broken down, after being partially sawn through from tho inside, and the teeth brought into con- tact by these means were carefully bound together with silver wire. Three weeks afterwards the septum nasi was severed above, by means of small an- gular bone forceps, aud then pulled down across tho fissure by a curved hook, so as to come in contact with the 0]iposite side, to which it was united by strong suture. The case is going on well, and the soft palate, the two halves](https://iiif.wellcomecollection.org/image/b22424751_0013.jp2/full/800%2C/0/default.jpg)
