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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![1(34 closed rapidly by granulations. From the first she was allowed to take nutiient fluids in small quantities and at frequent intervals, and after the 10th day could take ordinary diet. Three weeks after the operation the palate was quite united throughout; she could swallow without difficulty, and her hearing was good; her voice ap peared to have undergone little altera- tion, though occasionally she pro- nounced words on making the attempt without the disagi'eeable accent pecu- liar to thesecases; showing that she was not prevented articulating cor- rectly hy structural defonnity, hut did so merely from habit, and only i-equired continued and persevering efforts to overcome this in great measure.* The concomitant deafness which occurs in these cases, is attributed hy ^I. Deleauf to a dryness and almost always a chronic irritation of the mucous membrane of the throat, inconsequence of its exposure to the contact of the cold atmosiilieric air, which chronic inflam- mation extends to the middle ear, while Dieffenbach attributes it, with greater justice, to the closure of the eustachian tube. That the latter is the more ijrobable explanation is inferred from the rapidity with which the hear- ing was restored in this case, as in others, after the operation. Tlie improvement in articulation Avhich patients experience after closure of the fissure, is not so immediate as the gi-eater ease of swallowing, and never is so considerable as might, a priori, be anticipated; this is princi- pally owing, I believe, to a want of perseverance on the part of the patient, in learning an entirely new method of pronunciation, which is attempted un- der gi-eat disadvantages from liis hav- ing been so long habituated to the move- ments of articulation associated with cleft palate, and the necessity of delay- ing the operation till about the time of jiuberty. An operation, widely different to the foregoing, and which for the sake of * I have recently seen this patient, and find the iuiprovcnient in her pronunciation is great: it is twelve months since the operation, and dur- ing that period she has devoted herself to ac- quiring more correct articulation, a social posi- tion of importance to her depending on the result: slie has succeeded bevond her e.xpecta- tions, and has obtained the end in view. t Uecherehe Pratique sur les Maladies de rOreille. distinction T call the old operation, hasl been recently performed by ]\Ir. Skey, J in St. Bartholomew’s Hospital, upon* Eliza Smith, set. 23 years. She is a| stout and healthy-looking woman, whol had a congenital cleft palate, im))li-‘j eating to avei7 slight extent the palate 1 bones. The margins of the cleft were j about an inch in length e.xclusive of the 1 uvula, which was divided in the centre; | the left flap was not quite so prominent d as the right, and the corresponding 1 margin of the fissure was a little longer, j On making forcible attempts at deglu- | tition the halves of the uvula came to- gether, as seen by looking into the mouth. She stated, that to prevent fluids passing through the nose while ! swallowing, she had always been obliged . to hold the head back; that her speech, . which was considerably affected, had not undergone any improvement, and in her opinion was worse than when she | was younger. j After waiting such a time from her j admission as was deemed advisable, I Mr. Skey pared the edges of the fissure | with a small scaljiel in the usual way, removing just enough mucous mem- I brane to expose the thickness of the | velum at its margin. A small incision 1 was then made from the anterior ex- 3 ti'emity of the fissure directly forwards -J in the middle line; after this a lancet- d pointed knife was passed into the velum • I on its under surface, and a deep incision ] made, commeucing near the anterior I extremity of the fissure midway between the cleft and the alveolar border, back- j wards and outwards parallel with the j margin of the cleft for nearly an inch;*! and a half, and terminating external to . i the uvula. This was repeated on the J other side, and the flaps were then par-q tially detached from the bones both fl from the cleft and the longitudinal | incisions, after which, a sufficient inter-1 val having been observed, five sutures a were introduced by means of small curved needles held in convenient for- ceps, the san)e thread being passed^] through botli flaps. The posterior'] sutures were tied first, the parts coming together easily, but in tying those in j front there was slight difficulty experi- •■J enced in drawing the ^larts together, it ] being necessary to hold the first turn of d the thread by means of long forc-cps^ while the knot was being completed; andS while tying these, the longitudimd inci-B sions began to gape, but only at tlieirB](https://iiif.wellcomecollection.org/image/b22424751_0008.jp2/full/800%2C/0/default.jpg)
