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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![ing, have succeeded entii-ely on the tidal of the new method. Of these may be mentioned Mr. Tuson’s case, in which three previous operations' had failed, and Mr. Bowman’s case, in which he operated first according to tlie old plan, but imsuccessfully; and subso quently, on performing Prof. Fergus- son’s operation on the same patient, he succeeded.* * * § * From many cases that have come to my knowledge, I presume that the ojiB- ration for cleft palate, as usually per- formed, is frequently imsuccessful, and that it is among ^ose operations in surger)'^ which are least certain in their results. Its unfavourable issue is not so frequently owing to an unskilful perfoimance of the operation, as to a non-appreciation of the causes usually interfering with the healing of the j^arts, and the consequent inability oi the operator to effect their removal, so as to place the flaps in a favourable position for their imion when brought together by sutures. I apprehend that the principal obstacle to the union of the pared margins of the flaps, when thus appro.Kimated, consists in the involun- tary movements of the parts caused by muscular' action ; and that this is some- times so vigorous as materially to in- terfere with bringing them together. That this muscular resistance is not merely hypothetical the ojiinions of many who have written on this subject will testify. Sir Phillip Crampton re- marks :— “ Ketraction of the edges of the fissure, effected by the muscles of the palate, has always been acknow- ledged.”! Pancoast observes, speaking of the incisions requisite:— “ To divide the insertion of the palate muscles, so as to prevent their straining the sutured edges of tlie palate asunder.’’! Warren observes, alluding to the flaps:— “ They could be partially drawn out,, though with great rcsistance.”§ Another authority states :— “ From the involuntary movement of the flaps there is much risk of failure.” * To these may be added Mr. Gay’s case, to be presently related. t Dublin Journal of Medicine, vol. xxii. p. 134. ... $ American Journal of Medical Science, vol. xxxii. p. 71. , , § New England Quarterly Journal of Medi- cine and Surgery. 1843. A question naturally arises—What muscles areinstruraentM in the produc- tion of this resistance to the approxima- tion of the flaps? Referring to a recent work upon Operative Surgery,’* we find the cir- cumflexus-palati has a greater influence assigned to it, in this respect, than the other muscles of the soft palate. Judg- ing from the fact that the greater part of this muscle has a fixed bony inser- tion, and from the extremely small effect produced upon the corresponding flap by pulling at the fleshy belly of the muscle in dissected specimens of cleft palate, we should draw a different conclusion; especially when we observe the opposite condition of the levator- palati and ])alato-pharyngeus, and the altogether different effect produced upon the flaps by the slightest traction in the axis of the first of these muscles in similar specimens, 'riie levator-palati, palato-pharyugeus, and palato glossus, appear to me to be the muscles con- cerned in producing the tension alluded to, but more especially the former; and, in proof of this action, if any fur- ther evidence is wanting, I may advert to the negative evidence afforded by the complete relaxation of the flaps on the division of these muscles, and the re- moval of all resistance hy the incisions requisite for this purpose, which are of such a character as to afford no other reason for this than the division of the muscles themselves. Without attributing all the tension in the flaps, caused by bringing them together, to muscular action, because the small size of the flaps in some instances, and the consequent wideness of the cleft, must operate materially in pro- ducing it, in particular cases, where it is very great, yet I think it must be evi- dent that the muscular action of the parts is detrimental to their union; and that, if this can be removed without placing the patient in a more unfavour- able position than he occupied before, as regai'ds the operation, it is desirable to do so. That the patient is in a more advantageous state for the healthy union of the fissure, I will endeavour to show presently. There can be no great objection to the division of the tensor palati, if it be proved that the parts will not unite readily without, and in that case it should bo divided at the * Operative Surgery, by Frederic C. Skey, F.R.S.](https://iiif.wellcomecollection.org/image/b22424751_0010.jp2/full/800%2C/0/default.jpg)
