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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![and pillars of tlie fauces. The levatores palati, from tlieir conuectiou, by iutermiiigling of fibres witb tbelatter, as before described, allows them to act from tboir palatal attachment, so as to constrict the fauces, without the velum being drawn down. I apprehend that, in the various movements of the soft palate associated with deglutition and respiration, the elevators and dejiressors of the velum sometimes act as aiilagonists, both sets contracting simultaneously,as in closure of the fauces ; at other times one set contracts, and effects movement at its attached part by virtue of a permissive action of the other set, and that, by dif- ferent conibinatious of these movements, the function of the part is discharged. Jn this resi^ect these do not differ from more strictly voluntary muscles. From the relative position of the muscles of tlie soft palate, it will be observed that the levator-palati and palato-pharyngeus of each side being antagonists to each other and to those of the opposite side, and acting coincidently, when the union in the middle line of the palate is interfered with by congenital fis sure, the combined action of the two on either side will be to draw the flaps asunder. It may be asked—how is this action compatible with the approxima tion of the edges of a cleft palate dur- ing attempts to swallow ? The only explanation of this action of which I am aware is given by Prof. Fergusson, who stated, in his valuable paper on Cleft Palate, that the edges are pushed together by the superior constrictor and upper part of the middle one. There appears but little evidence in support of this explanation ; but, if attention be directed to the kind of curve the latej'al fibres of the constrictor make round the side of the velum, it will be perceived that, when the muscle acts, the force produced is directed from without inwards, and forwards; and hence it is not unreasonable to supj)ose that the same action which, in the normal state of things, effects the close approximation of the sides of the pharynx and velum, may, when there is cleft palate, and the muscles are put into inordinate action, as in the e.xpe- riment alluded to, materially assist in bringing the flaps together. Prof. Fergusson has alluded in his able pa])er upon the subject to some diffeionces between the anatomy of the ])arts in their natural and in their cleft condition, and has in his possession, which through his kindness I had an opportunity of examining, the dissection of a cleft palate taken from an aged subject: from this dissection he has observed tluit “ the palato phaiyngei muscles are not attached to each other as in the well formed palate ; these muscles are seen to form the principal part of the free margin of the palate, along the line of fissure: their course is somewhat semi-circular from their upper to their lower end, the convexity being towards the middle line ; and it follows that during action, if not opposed in any way, they must pull the parts out- wards.’’* I have recently had an opportunity of dissecting, in conjunction with Mr. Savory, the palate of a child two days old, the subject of cleft palate and hare- lip, which may be interesting in con- nection with the specimen above al- luded to, and from which it differs somewhat. The dissection is in the mu- seum of St. Bartholomew’s Hospital.f It will be observed tliat the palatal miiscles are remai'kably weU-marked at this early age, and in no respect differ from the same in their nonnal condition, as regards relative position, further than in their want of union in the mesial line. The right flap is the larger of the two, and has a broader bony attach- ment: the fissure, which is wdde, ex- tends through the hard palate, impli- cating the alveolar margin in front, and laying open the nasal cavity to the left of the septum: a vertical section has been made of the tongue and larynx, and the muscles of the right side dis- sected. The levator palati takes its usual direction from the base of the skull, in connection with the cartilaginous part of the eustachian tube, to the middle of the velum, where it spreads out immediately outside the azygos uvulae. The palato-pharyngeus spreads out at its upper part: one slip forms the free margin of the soft palate, nmning to the base of the uvulaj; the next fibres mingle more or less with the levator palati, but the larger portion of tlic muscle pursues a course outside aiul below the insertion of that muscle, in * Medical Times, March 6th, 1847. t Malformations. Series A, 10 a.](https://iiif.wellcomecollection.org/image/b22424751_0006.jp2/full/800%2C/0/default.jpg)
