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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![substance of which it blends; but it is more immediately connected at its inser- tion with thepalato-2'haryngeus,the j^rin- cii)ali)art of which usually runs beneath it. The two muscles are separated below by the azygos uvulfe, beneath which some of their fibres unite in the middle line. E.\:tending round its under and posterior surface is the concave upper margin of the superior constrictor; this consists of a thick bundle of muscular fibres, which ])ass from their attachment to the lower third of the internal pterygoid plate and hamular 2>rocess of the sphenoid bone,— at first, almost directly backwards, where they join with the fibres of the palato- pharyugeus; they then curve inwai'ds, and, ascending to the mesial line, are prolonged by aponeurosis to the basilar process of the occijiital bone. The circimflexus or tensor palati be comes tendinous before turning round fbe hamular process of the sjrhenoid bone, and is here jn-ovided with a beau- tiful synovial capsule, which would ap- pear to be associated more with the sharp turn made by the tendon, than as indicating much movement at this part; having ]iassed this, it immediately ra- diates into a fibrous expansion, situated horizontally, and is attached to the transverse ridge on the horizontal jilate of the ])alate-bone, to the extremity of t he alveolar arch of the superior maxilla, and also to the muscle of the ofiposite side, beneath the azygos uvulae. This fibi’ous expansion, by its density, serves as a point of union for the other mus- cles of the soft palate, gives firmness to the latter, more especially near its bony attachment, and jjrevents the sudden transition from bone to muscle which would otherwise take place at this part; it also enables the velum to maintain its ordinary oblique position midway be- tween that which it is made to assume during mastication and deglutition. The palato pharyngeus ascends behind the tonsil from the thyroid cartilage and side of the pharynx, and divides into two jiortions; of these, by far the larger passes upwards with an inclination for- wards and inwards beneath the levator, to the under surface of the circumflexus palati, in which they terminate, or are prolonged to the hard palate; the other division consists of a small band of mus- cular fibres, running more transversely, and forms the free margin of the jialate. Sojiio fibres intermediate between these two portions interlace with the insertion of the levator palati. The flrst*or longi- tudinal portion is situated, for the most l^art, between the levator and tensor palati muscles, and blends, on its outer- surface, with tlie pterygoid exti-emity of the u^rper concave margin of the superior- constrictor, the union of the two forming a muscular- bundle of considerable size. Occasionally a portion of the palato- ]rharyngeus passes vei-tically behind the levator palati to the side of the eusta- chiair tube, aird has been rramed sal- pingo-pharyngeus. The palatoglossus is the smallest muscle of the palate, and forms air arch, with the convexity outwards, imme- diately in front of the tonsU. It radiates at its palatal attachment; the middle fibres becoming somewhat tendinous, unite with those of the ojrposite side; those near the free border of the jralate run with the transver-se slip of the jralato- pharyngeus, while those hr front pass into the tendinous expansion of the circumflexus jralati. The fibres passing to the nriddle line, in conjunction with the longitudinal portion of the palato- phar-yngeus, with which they interlace, receive the insertion of the levator ^lalati of the same side by intermingling of fibres, and by this means these muscles can act antagonistically. The azygos uvula extends from a fibrous expansion in connection with the spine of the palate bones along the siqierior surface of the raphe, and termi- nates in the uvula. From this rough sketch it may be perceived that the lateral connections of the velum palati are almost entirely muscular; and this is impor-taut in rela- tion to the susceptibihty of the flaps, in cases of fissure of the jralate, to partici- pate in the general movements of the jiharynx, and also as afibrding an ade- quate explanation of the width of the cleft, lu-oduced, in the majority of in- stances, not by an absence of tissue, but by the tonic action of muscles unop- posed by their proper antagonists. It should be observed here, as hearing upon the subject (since the circumflexus j)alati has heen held out as the muscle having more influence in the production of tension of the flaps, after their union by suture, than the other muscles of the palate), that a largo jiroportion of the ai)oneurotic fibres of this muscle are inserted into bone, leavuig but a small portion which could possibly bo con- cerned in producing tension, and that](https://iiif.wellcomecollection.org/image/b22424751_0004.jp2/full/800%2C/0/default.jpg)
