Oral surgery : a treatise on the diseases, injuries and malformations of the mouth and associated parts / by Truman W. Brophy.

  • Brophy, Truman William, 1848-1928
Date:
[1916?]
Catalogue details

Licence: In copyright

Credit: Oral surgery : a treatise on the diseases, injuries and malformations of the mouth and associated parts / by Truman W. Brophy. Source: Wellcome Collection.

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    third month of intra-uterine life. Even when the palate is completely cleft the two halves of the uvula are clearly indicated as tags projected from the borders of the palatal folds. The dissection in the College Museum show the tensor and levator palati muscles well developed; the upper parts of the supe¬ rior constrictor and palato-pharyngeal muscles are stronger than in normal palates.”1 Among the many causes that have been assigned for failure of union of the palate within the first two months of embryonal life, the one advanced by the late Dr. C. F. W. Bodecker of Berlin is, I believe, most to be relied upon. It is based upon physiological and anatomical grounds. We know that in the formation of the teeth, the mucosa dips deep down into the submucous tissue, forms the epithelial lamina, which contracts into the epithelial cord at the dis¬ tal end of which the enamel organ is formed. It is too well known to admit of discussion that a layer of epithelium under certain conditions will form an obstruction to union of the tissues between which it intervenes. The illus¬ trations (Figs. 373 to 380) exhibited clearly present the passage of epithelium deep into the connective tissue in the enamel formation. It seems that Bodecker’s conclusions, namely, that this epithelial cord delays union of the parts forming the superior maxillae and, by reason of the force exerted by the tongue and mandible from the beginning of the third month until birth and several months later, accounts for the broad separation of the maxillary bones and the creation of cleft palate. Early Symptoms.—A new-born child, having a cleft palate, usually weighs more at birth than it will a few weeks later. The loss of weight is due to defective deglutition and nutrition and, not infrequently, to improper food. Lack of knowledge regarding infant food and feeding is very common. In the absence of harelip, the deformity of cleft palate is often not discovered for several days—sometimes weeks. This is a great oversight on the part of the obstetrician and nurse. It is the duty of the attending physician to make a careful examination of every child the day it is born to discover possible defects or abnormalities of any nature. An examination of the mouth having been neglected, the first indication of a cleft is difficulty in swallowing and regurgi¬ tation of food through the nose. Consequently, the child is irritated and distressed by its inability to receive proper nutrition. It develops gastro¬ enteritis, loses weight, becomes emaciated and many die of starvation. Symptoms in Adults.—The symptoms of cleft palate in patients later than in infancy, when accompanied by harelip are easily recognized, though the casual observer might easily be misled in assuming that one who has harelip also has cleft palate, since these deformities are not always associated. Those who have perfect lips and defective palates sometimes speak quite well, while many who have perfect lips and perfect palates speak with the nasal intonation which characterizes a cleft palate. The voice, therefore, is not an infallible symptom. An ocular examination quickly reveals the condition 1 Hence the value of these muscles in lengthening short palates (see page 709).