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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    lip. The latter had been operated on at the age of six months, and the alveolar processes. had since: come together, but had not coalesced. There was a long fissure extending from just behind the alveolar arch backwards, through the soft and hard palate. ‘The bones composing the roof of the mouth were, as may often be observed in these cases, shelv- ing posteriorly, making the fissure of great width, and icreasing the difficulty of dissecting off, and approximating the soft parts that cover them. The speech was rendered, by this malformation, scarcely intelli- gible. The operation was performed on April 4th, 1846, with the assistance of Drs. H. J. Bigelow and Briggs, as follows: The patient being placed in a good light, in front of the window, with a long spear-shaped knife, curved on its flat side, and cutting for half an inch on both edges, the mucous membrane was dissected from both sides of the palate, as far forwards as the anterior angle of the fissure, and backwards to where the soft palate joins the ossa palati. A pair of sharp- pointed scissors, curved like the knife on the flat side, were now carried behind the soft palate, and the attachments of the latter to the ossa pa- lati cut away, leaving the mucous membrane in front intact, thus afford- ing a continuous flap. ‘The uvula was next seized on either side, and the parts being made tense, the posterior pillar of the palate was freely divided, and the dissection continued backwards, until the flap expanded, and not the least resistance was offered to any manipulations. Six su- tures were rapidly introduced without difficulty. Before tying the ligatures, it was found necessary again to loosen with the curved scissors the attachment of the soft palate to the bones. In doing this, an artery was divided, probably the palatine, which gave rise to a troublesome hemorrhage, so that the ligatures were not tied until the bleeding had ceased in the afternoon. In half an hour it again returned, and continued to the amount of half a pint. ‘This is the only time trou- ble has ever arisen from this cause, within my knowledge. After the first day, the patient was allowed gruel, or drink, every four hours. Owing to the uritation from the bleeding, and the coagula forced between the parts, the stitches at the upper end of the wound gave way. The soft palate united well. As I intended to repeat the operation on the hard palate, I advised him for the present not to have an obturator applied. Case II.—Miss J., of Andover; applied to me in April, 1846, with a congenital fissure of the soft and hard palate of the worst form. The bones were so widely separated, and to such an extent, that I told her at once it would be impossible to close the whole aperture by any surgical operation.» As she was extremely desirous that something should be done to improve her speech, I agreed to make the attempt. The membrane was dissected from the hard palate, as far forward as was thought useful, and the operation already detailed in the account of the preceding case repeated upon the soft palate. The bleeding was tri- fling. Five stitches were introduced, and easily tied.. This patient was allowed half a pint of liquid nourishment three times