Observations on cleft palate and on staphyloraphy / by W. Fergusson.

  • Fergusson, William.
Date:
[1847]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on cleft palate and on staphyloraphy / by W. Fergusson. Source: Wellcome Collection.

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    like it, armed with a thread of a similar length but much thinner, should be passed in like manner through the other side of the cleft palate, exactly opposite the first puncture, and similar manoeuvres should be repeated. By fixing this second thread to the bent end of the first, where it is hanging out of the mouth, and then withdrawing it in the course through which it has already passed, the thread intended to form the stitch will thus be brought through the opposite side of the palate, when one end of it (for it has as yet been double) can be drawn out so as to leave both ready for knotting. Two, three, or four more threads, as may seem requisite, can be introduced in a similar manner; and now all that remains to be done is to draw the edges together and fasten the threads. The foremost thread should be first tied in accord¬ ance with the ordinary mode of making the interrupted suture; and the others should then be treated in the same order in which they have been introduced. Should an additional suture seem requisite in any part of the fissure, it may now be introduced by pushing the same needle from one side to the other —for now, when the parts are more fixed by the sutures, this may readily be accomplished. Before fastening the two knots furthest back, the pared edges should be brought together to ascertain the influence of the palato-pharyngeus in dragging them asunder. If this action seems strong, or if there be difficulty in drawing the parts together, the threads should be pulled forwards, whereby the posterior pillars of the fauces will be put upon the stretch, when each should be cut about half an inch behind the uvula, in an outward direction, to the extent of a quarter of an inch, and then there will be greater relaxation. Long curved '■ ■ scissors, with blunt points, like these (fig. 8), are such as I use for this part of the proceedings, and the same are good for cutting off the ends of the ligatures, which is the last step in the operation. In some instances it may appear best to effect the division of the palato-pharyngeus before passing the stitches. If this be desired, the fibres can be put on the stretch by drawing the uvula forwards with the beaked forceps. It will rarely seem requisite to meddle with the palato-glossus, but if its division is thought advisable, the scissors just referred to will be the best instrument to use. A small horizontal wound in front of the tonsil, and about midway between the tongue and palate, as represented in fig. 9 (c), will suffice. The hookbeaked forceps, and also those for seizing the threads, should be a little longer than those in common use; and the curved needle is similar to that often employed for the strangulation of hemorrhoids, nsevi, and such like growths. This figure (fig. 9) will probably, in some degree, elucidate the above description. It gives a view of the posterior nares, with a cleft impli¬ cating the whole of the soft palate, and a small portion of the hard. On the left side the mucous membrane has been dissected from the muscles, a. The levator palati, on which is marked the line where it should be cut across, b. The inner bundle of fibres of the palato-