On the treatment of cleft palate / by Lawson Tait.

  • Tait, Lawson, 1845-1899.
Date:
[1870]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of cleft palate / by Lawson Tait. Source: Wellcome Collection.

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    There is one very objectionable result of the operation for hare¬ lip which I have endeavoured to obviate, and I believe successfully. I mean the scars left by the needles when used transversely to close the wound. The only difficulty about the operation is with regard to the time during which needles so employed ought to be retained. If removed too soon, the wound is torn open; if removed after the second day, hideous and ineradicable scars are produced. To avoid these scars I use ordinary sempstress’s needles, strong and threaded with a few inches of silver wire double. I introduce each needle through the lip (in the plane of its surfaces), about half an inch from the prolabium, and bring the point out at the middle of the cut surface. I then introduce the needle at the corresponding point of the opposite cut surface, and again bring it out at the root of the ala of the nose. Thus, when both needles are in situ they form a St. Andrew’s cross, the point of intersection being in the centre of the wound. The needles are then pushed home up to their eyes, the wires twisted firmly together, the points cut off close to the skin, and the stumps retracted into it. Thus all possible scarring is avoided, save on the mucous surface of the lip, where it cannot be much noticed. I have a modification of this plan to secure a prominent pro¬ labium, but I cannot by description render it very intelligible. The wires are made by it to pass through the prolabium instead of over it. The next most common variety of intermaxillary cleft is that involving the soft palate, and from a third to two thirds of the hard palate, sometimes with, but more frequently without, harelip. Next in order of frequency is the complete cleft, and least frequent is the simple cleft of the soft palate, with which I have only twice met. It is, perhaps, not strictly correct to include all these varie¬ ties under the term intermaxillary cleft; but as this is the best name for the complete cleft, and as all the others are but modifica¬ tions of it in their origins, and in the treatment I propose differ but very slightly, I find it the best term to use for all. In detailing the method of treatment which I have pursued in cases of complete intermaxillary cleft I shall, with very few excep¬ tions, give all the details necessary for clefts of more limited extent. I must first of all, however, take exception to a statement by my friend Mr. Thomas Smith, in his paper in the fifty-first volume of the f Medico-Chirurgical Transactions,’ to the effect that Sir William Tergusson has brought nearly to perfection the operation for cure of the soft palate by division of the muscles, and that almost as much has been done for the hard palate, so that there is “ as little room as need of improvement in the modus operandi for the cure of these deformities.” I think it premature to say so much when we know very well that at least half of the children born with extensive clefts die within a few days after birth, from starvation; and when we know also that the