Illustrated medicine and surgery. V. II, no. 1, 1883 / edited by George Henry Fox and Frederic R. Sturgis ; with the co-operation of Willard Parker [and others].

Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Illustrated medicine and surgery. V. II, no. 1, 1883 / edited by George Henry Fox and Frederic R. Sturgis ; with the co-operation of Willard Parker [and others]. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    B Fig. 113. This was done, and there was sufficient material for the flaps to overlap in the central line. A small strip was removed from each flap and the edges accurately joined together. The union was complete throughout. The sutures were removed, and I felt sure of a satisfactory result. In about a week I found the line of union growing thin and showing indications of breaking away. An examination with the laryngeal mirror in the nasal cavity showed that granulations were springing up at the angles c c, and a line ot ulceration was visible along the nasal surface of the wound, B. The union of the flaps Anally gave way, and they assumed almost their original position in contact with the bony walls, A A, with the exception of a piece about one inch in width, at a point near the posterior edge of the hard palate. No further operation was permitted for the relief of this part of the deformity. Operation, for the Restoration of the IAp.—March 21st, 1878. The piece of integument cover- ing the inter-maxillary bone was dissected up to the tip of the nose, and the projecting bone containing the incisor tooth was removed with bone forceps. The piece of integument which had been lifted up was then trimmed, turned down and accurately adjusted against the raw edge of the septum, so as to form a columna; this was retained in place by two silver wire and shot sutures, running directly through the septum. The union was perfect. On April 17th the following operation was performed: The two portions of the lip were separated freely from the superior maxillary bones and a piece was removed on either side of the cleft by a pair of curved scissors. The posterior extremity of the newly formed columna was freshened, the edges of the fissure were brought together and retained in position by two pin sutures and a number of fine interrupted silk sutures. The columna Avas also nicely adjusted in the upper portion of the fissure. Good union took place everywhere except at the columna and the right side of the lip, and a considerable notch was also left in the centre of the lip. The boy Avent home during the summer to allow the parts to become soft and more yielding. He returned to the hospital December 9th, 1878. The edges of the opening between the columna and lip Avere freshened and closed with sutures. The union Avas perfect. On December 27th the final operation Avas performed on this case, and was for the purpose of relieving the notch at the line of union of the lip. Wharton Jones’ operation, consisting of two incisions through the entire thickness of lip, on either side of the median line, extending from a point just below the columna downwards and outwards to but not through the vermilion border, forming an inverted Y incision, was performed. The Y-shaped flap included between these incisions was then pulled doAvn, so that the notch was obliterated ; the upper portion of the incision Avas closed by a pin suture, and the remaining portions by fine silk sutures. The lines of the incisions left after this operation Avas of the form of an inverted Y. The final result is illustrated in Plate XYIII, Case I. Case II.— John, aged 9. The operation performed December 12, 1878, for the formation ot a new columna, was the same as in Case No. I. On January 10th, 1879, the columna formed by the first operation being too prominent, its integument was dissected up and replaced after another portion of the bony septum had been removed, resulting in a Avell-formed columna. The operation on the lip Avas the same as in Case I. resulting in perfect union. Its appearance is shown in Plate XVIII, Case II.