Cleft palate and harelip.

Date:
1908
Catalogue details

Licence: Public Domain Mark

Credit: Cleft palate and harelip. Source: Wellcome Collection.

Provider: This material has been provided by the University of Toronto, Harry A Abbott Dentistry Library, through the Medical Heritage Library. The original may be consulted at the Harry A Abbott Dentistry Library, University of Toronto.

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    have followed this lead with perhaps the same end in view, or because it never seemed worth while to think othenvise. But surely it is worth while when the child's ability to speak without nasal intonation depends upon the early operation. It is often urged that if the lip is done first, the cleft in the palate narrows materially, and a less extensive operation will be required for its closure. While it is quite true that the cleft becomes less wide under such circumstances, yet to my mind it does not lessen the extent of the operation, for I think it may be laid down as an axiom that the older the child, the more grave is any opera- tion that may be undertaken upon its palate. There is greater danger from hemorrhage, from infection and from shock. Lane ^ makes out a good case for operation upon the palate before the deformity in the lip is touched, and in most instances I agree with him. If the palate is done first access to the field of operation is easier, and the surgeon has better control of his technic. As a rule the cleft in the lip may be attended to at the same operation, with the one anaesthetic. The flap operation as outlined by Lane is a most excellent one, and in his hands has given gratifying results. It seems to me, however, that unless the operation is done mthin the first few days of life, there is a serious risk of doing damage to the temporary teeth when it is necesary to go outside the alveolar margin for a large flap. Then, too, in older children one cannot go outside the alveolar margin because of the erupted teeth, and as it will probably be another half century before the profession really becomes alive to the advantages of early operation, I feel prone to recommend a modification of an operation already described by the Avriter.^ The patient is placed on its back with a small sandbag under the shoulders, and the occiput resting on the edge of the table. The anaesthetist is on one side, and should be prepared to administer oxygen at any moment in conjunction with ether or chloroform, whichever may be selected as the anaesthetic. As a preliminary step to the operation the tongue is drawn well forward and a stout silk suture passed through it. The ends of this suture are then caught in a pair of artery forceps which in turn are clipped into one of the towels over the patient's chest and thus fixed, saving one hand of an assistant. A pair of Lane's gags