On restoration of the upper lip / by R.J. Mackenzie.

  • Mackenzie, R. J. (Richard James), 1821-1854.
Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: On restoration of the upper lip / by R.J. Mackenzie. Source: Wellcome Collection.

    4/6 (page 4)
    tion of the upper, whilst its place was supplied by the flap from beneath, and the right side of the mouth was now formed by the incision (EC) between the two flaps. Fig. 2 explains the position of the parts when united in their new situation. The operation was tedious and embarrassing from the unsteadi¬ ness of the patient, owing to the extreme difficulty of bringing her under the full influence of chloroform,—a difficulty which was expe¬ rienced previously in removing two projecting teeth, and equally so afterwards in the operation for the restoration of the nose. She suffered from very little constitutional disturbance, however, and perfect union of the parts was obtained in the course of a few days. A new difficulty, however, presented itself in the contraction of the mouth, which, in spite of all endeavours to prevent it, went on till the entire granulating surfaces of the two flaps had united. This contracted state of the mouth was afterwards obviated to a considerable extent by an incision, in which the integument and mucous membrane were divided at different levels. The mucous membrane was then everted and united to the skin, so as to form a prolabium for the upper lip, whilst the skin was similarly inverted and united to the mucous membrane of the lower lip. The mouth was thus enlarged; but a small portion of the lower lip was unfor¬ tunately lost by sloughing, which has left a slight permanent defi¬ ciency at the lower part of the angle of the mouth. About ten weeks after the first operation, when the parts were firmly cicatrised in their new situation, the nose was restored by bringing a flap from the brow. The operation was performed in the usual way, with the exception of the columna being taken from the scalp, according to the Indian method. This was done, as it was thought better not to interfere further with the new lip, which would have been considerably diminished in size by raising a columna from its centre. About a month after the formation of the nose, the collateral cir¬ culation of the new organ being well established, I divided the twisted neck of the flap, and attached it in the usual way. The sketches at p. 5 show the result of these operations. The front face is from a daguerreotype, which, with a sketch of the profile, was taken five months after the formation of the lip, and three months after the restoration of the nose. The nose appears large,—a fault which, I need scarcely add, is unlikely to be perma¬ nent. The chief difficulty met with in the progress of the case arose, as I have observed, from the obstinate contraction of the mouth; and the error committed in the operation, which gave rise to this diffi¬ culty, consisted evidently in the removal of the prolabium. This inconvenience, I have since found, may be avoided by preserving the prolabium of the lower lip in its situation, and uniting it to the flap brought up from over the base of the jaw.