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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![iplacc most convenient to restrain its iiactiou. Now the longitudinal incision through itlie palate, as recommended by Dieffen- Ihach, is an application of the same kind I of treatment that is practised upon the [perineum, and other parts, in cases in vwhich tlie tension is occasioned, not by tthe muscles acting on tlie incised parts, ?so much as by a sti'etching of them in (.certain movements of the body, or re- r suiting from a loss of substance in the '.gap to be filled up by simple approxi- imation of its edges. In the case of cleft palate, it appears tto me that the conditions are not similai*, (and that the incisions, were they neces- ssary for this purpose, iirespective of the 1 action of the levator palati, woxild be ; advantageously made on the upper sur- tface of the velum rather than the lower, (on account of the elevation of the flaps, 1 accompanying the very high arch of the [palate in such cases. It has been urged by some, who still 1 remain attached to the old method, that I the vai’ious incisions suggested by Diefienbach, Pancoast, and others, for 1 relieving the tension of the parts, would i include considerable portions of the I muscles in question : but it should be I remarked, that these incisions are not I calculated to effect this purpose, from 1 their being made for the most part in I the direction of the muscular fibres, in- : stead of across them : the only muscle I that would be likely to be divided is the 1 tensor palati, and the tendinous ex- ipansion of that muscle being situated I near the upper surface of the velum, would require the incision to extend through the soft palate, and pass into : the nose in order to ensure its divi- ; siou. Among the disadvantages of this in- ' cision, as compared with the other, did it answer the purpose intended, may be ' enumerated the following:— 1. The larger size of tlie wounds. 2. The severity of the pain occasioned by the greater sensibility of the parts incised, and consequent excess of in- flammation, frequently of an unhealthy character, ensuing. 3. The kind of wound, which is al- most entirely glandular, and is more likely to be the seat of unhealthy in- flammation, when there is a tendency to it, than a muscular wound. 4. The irritation of the wounds by the necessary amount of nourishment. 5. Their near proximity to the cleft, where it is desirable that the healthy process should go on quietly. 6. The difficulty of swallowing, from the gi’eater soreness of the pai’ts, as as- certained fi-om patients themselves. To these may be added the want of success in the old operation generally; of which, numerous instances, were it necessai’y, might be adduced. On the other hand, in Fergusson’s operation, if I am not gi’catly mistaken, the majority of these objections are ab- sent. The patient can take nourish- ment with comparative ease; there is less pain both during and after the operation; the wounds are at a distance from the cleft, and consequently they do not interfere with the union of the parts. The incisions themselves are not so much in the way of irritation, so that the patient can take nutrient fluids, from the first, without inconvenience : besides these, as a result of the different principle of the operation, the flaps are rendered loose and flaccid, being for the time almost completely pai'alysed. The operation is in no respect more difficult, and is generally attended with less bleeding. Since Mr. Fergusscn first made known his operation to the profession, in a paper read before the Medico-Chirurgi- cal Society in 1844, others have had opportunities of practising it; and though the views held out in that ela- borate and valuable jmper have been very tardily received, yet, unlike many new operative [iroceedings, it has met with Mmost invariable success in the hands of aU who have put it in practice. Mr. Avery has informed me of seven cases in which he has operated for fissure implicating the hard palate, as well as simple fissure of the velum, all of which succeeded perfectly. A detailed account of three of these cases is con- tained in the Lancet, Sept. 21; 1850. Of the 29 cases recorded by Messrs. Fergusson and Avery, 20 were success- ful. Some of these were very unfavour- able, as the ordiuai-y o[)eration had already failed. Of the three failures, two were unfit cases for any operation; in one. Dr. WaiTen’s plan of separating the tissues from the hard palate was tried; another (a case of ]\Ir. Shaw), is stated to have been unfavourable for any operation: tho failure of the third, Mr. Fergusson attributed to removing tho sutures on tho second day, tho flaps](https://iiif.wellcomecollection.org/image/b22424751_0011.jp2/full/800%2C/0/default.jpg)
