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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![1 165 anterior half; it was deemed necessary before tying the last sutures to separate the soft pails from the palate bones a little more - extensively. After the closure of the cleft the anterior pillar of the fauces on the right side being tight, it was diiuded with a scalpel, and the part seemed considerably re- lieved by the incision. The operation continued a little more than an hour, and did gi*eat credit to the well-known skill of the operator, though the pro- gress of the case is, I fear, at present very unfavourable, and scarcely promises union of any part. From the earliest jicriod when an ope- ration for uniting cleft palate was re- sorted to, up to the time when Prof. Fergusson’s paper was published in 1844, but little improvement of this troublesome affection had been sug- gested, beyond various collateral inci- sions into the neighbouring soft parts, as pi'actised by Dieffenbacli, lloux, and otbei*s, for the purpose of preventing, or relieving, the tension of the flaps which occurs when they are brought together by sutures. In that jmperhe desciibed an entirely new method of operating, the principle of which had been sug- gested to his mind during a careful study of the anatomy and pltysiology of the soft palate, both in its natural and in its cleft condition. From these investigations he discovered that the action of the muscles of the palate was a serious obstacle to the success of the operation of staphylora]>hy as pre- viously practised. He therefore nro- posed “ that the surgeon should, on stiictly scientific princi])les of myotomy, so conduct his incisions as to destroy all motory power in the soft ])alate, for the time being, and thus permit that repose of the stretched velum so essen- tial to a hap])y result.”* This improvement in the operation was the jnore necessary, as its complete failure, owing to some cause or other, had been of no ixucommon occurrence, even in the hands of skilful men ; and, consequently, the operation was iVe- quently declined, on the gi-ound of its doubtfid result and the difliculty of performing it. The afflicted applicant was thus compelled to continue in the same state, unfit for society, and unable to swallow his daily food with comfort. * Medico-ChirurgicttlTransactions, vol. xxviii. Tlie conclusions which Mr. Fergus- son arrived at were:— 1. That the flaps are drawn upwards and to the sides when the levator palati muscles contract. 2. That, when the levator palati and palato-pharyngeus act strongly toge- ther, the flaps are So forcibly drawn from the mesial gap_ that they can scaj'cely be distinguished from the sides of the pharynx. 3. That the parts are foixed together when the superior constnetor contracts during the act of deglutition. 4. That the circumflexus-palati pos- sesses but a feeble action over the flaps. The principle of this operation is to divide those muscles of the palate which have the power of drawing the flaps from each other, in order that the parts may be placed in a state of repose, and the joined edges of the cleft may not be pulled asunder by any convulsive action of these muscles during the pro- cess of union; the muscular wounds healing simultaneously wiih the fissured velum. The course adopted by Mr. Fergusson is obviously a right one; and, were the same system pursued in the investigation of truth in all in- stances, 1 apprehend more satisfactory results would be obtained. The direc- tion given to surgical treatment sug- gested by an accurate knowledge of the anatomy and physiology of the parts concerned, is one of tlie gi’catest im- provements of modern jiractice. In considering the relative merits of the two operations, gi’cat disadvan- tage is exjxerienced in our being unable to call in correct statistical rejxorts of cases. Such reports cannot be advan- tageously adduced for or against either jnocceding, in consequence of their not furnishing an accurate account as to how many times the operation of sta- l)hylorapby lias been jierformed. As regards the experience of the eminent surgeons of this metrojiolis, who have devoted some time and attention to this subject, each method has jiroved successful, with rare exceptions, in their respective hands. Cases in which the new proceeding has been deemed nnadvisablc have suc- ceeded under the old operation.* On the other hand, cases wdiich have failed, more than once, under the old iiroceed- * A case of this kind lias huen mentioned to me by my friend Mr. Savory.](https://iiif.wellcomecollection.org/image/b22424751_0009.jp2/full/800%2C/0/default.jpg)
