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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![bhe direction of the fibrous expansion of hhe tensor palati. Tiie palato glossus is well marked, and as regards relative size is somewhat large)’ than in the adult. The fleshy portion of the tensor palati is large, bpt owing jtoo the imperfect development of the piterygoid plates it is very shoi't, and Its tendinous expansion has not acquired Buflicient denseness to be recognised as tsuch. The azygos uvulm is of consider- fcible size, and each half occupies a free iraargin of the fissure. (Case of Cleft Palate successfully operated on according to Professor hergusson’s method. Mary DeiTy, jet. 20, a healthy-looking fjirl, was admitted into the Royal Free [Hospital, under the care of Mr. Gay, ror a congenital fissure of the velum lalati, which she was anxious to have operated upon. The pharynx was quite lealthy, and the fissure, which was isituated in the mesial line, extended iquite through the soft palate, but did lot implicate apparently the bony Btructures, and divided the uvula into v.wo equal portions : each flap was of fii-m raonsistence, and sufficiently moveable lud abundant to admit of the edges I'oomiug nearly in a])position mesially, iluring forcible deglutition : this move- inent, which has been alluded to before, may be easily seen while the patient ittempts to swallow a small quantity of Iluid with the mouth open, but requires u little practice to enable it to be done asily. On iiTitating the flaps by means of a oointcd instrument, each was drawn upwards and outwards, as it were spas- modically, so as to be almost buried in il;he sides of the phai^nx. Her mouth rvas rather small; but, on the other nand, the great patience and determina- lion that she manifested, together with i:he healthy state of the flaps and ■)har.ynx, rendered it a favouralde case or operation. She stated that none of aer relatives were remembered to have lad a similar affection, and her mother ■xttiibuted it to having seen a child with ■ideft palate during her pregnancy ; that l-hhe had never been able to swallow luids without a portion passing into '.he nose, but that by throwing her bead oack she was enabled to prevent its escape externally: her speech was un- lasually indistinct for a cleft of the soft palate only, and she comjiluincd of deafness. The girl being in good health and spirits, the operation for its cure was performed by Mr. Gay, after Professor Fergusson’s metliod, in the presence of Mr. Wakley, Mr. Henry Smith, and others. After section of the levator jialati of one side, the corrosjionding flap became incapable of being drawn up in the spasmodic way before alluded to upon iriitation with a pointed instru- ment, and presented a strong contrast to that of the opposite side when simi- larly irritated: and after division of both levator palati muscles, tlie flaps were observed to have fallen towards each other, so that the cleft was reduced to about half its former size; the in- cisions were made freely, and the flaps were rendered by them loose and flaccid, and they could now be easily brought together without producing any tension : it was therefore deemed unnecessary to divide any other muscles The flaps were then dissected from the hard palate for a short distance in front of the cleft, to facilitate the closure of -the parts at the angle of the fi.ssure. The margins of the flaps were freely pared, and brought together by five sutures, according to Prof. Fergusson’s method, a detailed account of which will be found in his papers on the subject. Tlie introduction of the sutures was found to bo the most difficult part of the operation; they were tied, in order, from before backwards, those parts being closed firet where there was most diffi- culty in their approximation. The bleeding, which was very trifling, was easily ari’ested by gargling with iced water previous to tying the sutures. During the operation the jiatient re- mained tranquil, and appeared to suffer no particular pain; but the continued efforts to repress coughing, wliilo the irritation of the fauces was going on, together with her restrained jiosition, produced slight faintness, which, how- ever, passed oH' quickly. She slept well duiiug the following night, and the next morning felt only slight sore throat,—no more inflam- mation followed than was necessaiy for the union of the parts; the stitches were removed four days after the operation, and union was found to have taken ])lace throughout, except the halves of tlie uvula, and a.small piece adjoining the hard palate. The latter afterwards](https://iiif.wellcomecollection.org/image/b22424751_0007.jp2/full/800%2C/0/default.jpg)
