Fissure of the soft and hard palate / [Jonathan Mason Warren].

  • Jonathan Mason Warren
Date:
1848?]
Catalogue details

Licence: Public Domain Mark

Credit: Fissure of the soft and hard palate / [Jonathan Mason Warren]. Source: Wellcome Collection.

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    fissure, and recommends the division of the palato-pharyngeus, which forms the principal bulk of the posterior pillar of the palate, of the leva- tor palati, and, in some cases, of the palato-glossus, in part, by a sub-mu- cous incision. ‘The effect of this is to paralyze the powerful action of these muscles on the palate, and thus remove one of the most important obstacles to the success of the operation. The same result is produced by the method above described, and al- though in my first paper no stress was laid on the division of muscular fibres, yet to any one who employs it, the effect of the incision of the posterior pillar, in destroying muscular action, will be at once apparent. [I have long been in the habit of calling the attention of those present and assisting me in these operations, to the facility and rapidity with which all the subsequent steps may be rhade, such as passing the sutures, tying the knots, &c., formerly the most embarrassmg part of the whole proceeding. The sutures may be introduced with a delicate curved needle, carried on a forceps with a movable slide, or, in cases where they are to be made through the mucous membrane of the hard palate, which, as often hap- pens, is too much contracted to allow of the manceuvres of the needle and forceps in carrying the stitches from before backwards, I have used the crochet-aiguille of Schwerdt. This instrument consists of a double hook, pierced near its point with an eye, having a mechanism like the spring-forceps of Assalmi. The needle being threaded, and passed through the edges of the wound, from behind forwards, the thread is caught by a tenaculum. One handle of the spring-forceps is now pressed upon, which opens the instrument laterally, and allows the thread to es- cape, and the needle to be withdrawn. ‘The ligatures are secured with the greatest ease by means of the surgeon’s knot, and from the almost entire impassibility of the parts, the knots will seldom be found to slip. The after-treatment of the patient is at present greatly ameliorated ; and experience has taught me that liquid food may be taken in the quan- tity required, whereby the inflammatory process which formerly followed, and was so much aggravated by the deprivation of fluids, is only suffi- cient for the healthy adhesive process necessary to close the wound, In order to illustrate some important practical points in the operation and treatment, I have determined, at the risk of tediousness, to give in detail the history of ten cases of fissure of the soft palate, which have been under my care within the last two years. Case I.—G. W., of Freeport, Maine, applied to me with a congenital fissure of both the hard and soft palate, complicated at birth with hare