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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    connection several points present themselves for consideration. Of prime importance is the question, At what age should the operation be performed? It may, T think, be laid down that, whilst it is never wise to operate upon a child under three years of age, the time of election is from tPiis age up to six years. However severe and complicated the case may be, no advantage can accrue from postponing the operation longer than the sixth, or at the very outside limit, the eighth year.'' Cheyne and Burghard,-* in their Manual of Surgical Treat- ment, put the matter in the following way: The age at which uncomplicated harelips may be operated upon depends to a large extent upon the size of the gap. In slight, simple cases the opera- tion may be done within a few weeks or even a few days of birth. If, on the other hand, the cleft is wide, extends up into the nostril and entails a long operation and a free separation of the soft parts from the bone with a considerable loss of blood, the operation should be delayed until the child is at least three months old. This must certainly always be the case in double harelip. In all cases, how- ever, imless there be some very strong contraindication, such as marked marasmus, the operation should be performed before the occurrence of dentition. When cleft palate complicates harelip, the question whether the operations for uniting the harelip and the cleft palate should be done at the same time or separately has to be considered. It is a generally accepted rule, and one with which we are in the main disposed to agTee, that the harelip should be closed as soon as possible, whether the operation on the palate be deferred to a later period or not. This is advisable, because the development of the parts improves directly the lip is united, the cleft in the palate, and especially in the alveolus, apparently tends to diminish and the nutrition of the child becomes better. From a study of the last sentence here quoted note that they claim that^ the development of the parts improves directly the lip is united. If that is the case in the lip, why not in the palate ? It looks to the ^\Titer as if some one of the Early Fathers in Surgery had laid down a law as to the age at which the operation should be done—perhaps hoping that death from maZnutrition might occur during the period of waiting—and that most writers since