A manual of the injuries and surgical diseases of the face, mouth, and jaws.

  • Marshall, John Sayre, 1846-1922.
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: A manual of the injuries and surgical diseases of the face, mouth, and jaws. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    465/750 (page 437)
    Hare-Lip.^—In uniting- fissures of the lip it is important to con- serve as much of the tissue as possible, in order that the lip may not be unnecessarily contracted. Various methods have been devised to give a normal shape to the free border of the lip and to prevent the notched condition which so often follows hare-lip operations. In all operations for closing fissures of the lip it is important to dissect the lip from the alveolar process upon either side of the cleft for a considerable distance backward, in order to gain as much tissue as possible and to prevent strain upon the freshly-united edges of the cleft. The common method of uniting a cleft in the lip is simply to pare the edges with a curved bistoury, inserting it at the angle of the cleft upon one side and then upon the other, and carrying it through the lip to the vermilion border, removing a paring the full thickness of the lip, or obtaining the same result by trimming the edges with the hare-lip scissors. The edges are then brought together with sutures of silk, catgut, or hare-lip pins. The lip-compressor may be necessary to con- trol the hemorrhage from the coronary arteries until the sutures are ready to be placed. Tying of these vessels is rarely if ever necessary. Fenger, of Chicago, has lately devised a new operation for hare- lip, which consists essentially of utilizing the parings of the fissure to lengthen the border of the lip, splitting the edges of the flaps and unit- ing the edges of the mucous membrane and the skin by separate lines of sutures, this part being similar to the operation of Tait for uniting the lacerated perineum, and also that of Marcy for closing the velum palati. Fillebrown, of Boston, recommends the following operation, which is similar to that devised by Nelaton, for relieving the notched condition of the lip so frequently seen in the border after operation for single fissure of the lip: A male, aged thirty, a patient in the Harvard Dental Hospital, came to have an obturator constructed for cleft palate. The cleft in- volved the hard as well as the soft palate, and originally a hare-lip. The lip had been operated on, and of course much improved, but the characteristic notch was present. (Fig. 177.) It had long been my belief that this deformity could be remedied, and I hailed with pleasure the opportunity to apply the remedy. The operation performed for it is shown in the illustration here presented. It was the result of study, experiment, advice, and acci- dent, and its success entirely fulfilled my expectations and hopes. By comparing the two cuts and noting the position of the letters, the operation will be fully understood. The line a-b. Fig. 178, represents the cicatrix left by the former operation. The line c-d shows the line of the incision transversely across the lip.