Observations on cleft palate : with cases illustrating the new operation of staphyloraphy / by William Fergusson.

  • Fergusson, William.
Date:
[1849]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on cleft palate : with cases illustrating the new operation of staphyloraphy / by William Fergusson. Source: Wellcome Collection.

    11/20 (page 11)
    have been enabled to close the whole gap by bringing the parts together in the mesial line; but almost invariably the junction in front has given way in a day or two after the stitches have been withdrawn, seemingly in consequence of the contraction induced by the soft struc¬ tures resuming their original attachment to the bones. Sometimes a small slough has formed in this locality, but I have not perceved that the opening has been larger on this account after the parts had been completely healed; the size of the fissure here being regulated chiefly by the deficiency of the bones. The following cases illustrate many of the general observations already made, and afford evidence of the utility of the practice inculcated. Case i. D. P., set. 17. The details of this case are given in vol. xxvii. of the Medico-Chirurgical Transactions. Since that publication I have repeatedly seen this gentleman, in whom the benefit of the operation has been more strikingly evinced than in any other of my patients. This I attribute, in a great measure, to his zeal in the study of elocution. Case ii. Miss W., set. 18. The particulars of this case also are given in the volume above referred to. The improvement in speech, since the operation, has not been remarkable. The palate itself has been rendered more perfect than in the preceding case; but, from timidity or want of energy, the lady has taken little or no advantage of the improved condition of the parts. Case m. (>. D., aet. 18. The fissure extended through the soft, and the greater portion of the hard palate; and the soft parts were so narrow, that I hesitated in recommending an operation. On the 4th of January, 1845, I operated on the patient: in addition to making the incisions devised by myself, I dissected the soft tissues on each side of the hard palate from this part of the fissure, in accordance with the directions of Dr. J. M. Warren; and, by this proceeding, was enabled to close the whole gap at once. Sloughing took place through¬ out the greater extent of the junction; and, on the fifth day, the fissure was wider than ever, the margins on each side, between the stitches, having given way. The operation was a complete failure ; and I attri¬ bute this result to the ligatures having been placed too near to each other, and drawn too tight, so that sufficient circulation was not permitted. Case iv. J. T., 8Bt. 23. This patient was sent to me by Mr. Tuson, of the Middlesex hospital. That gentleman had operated three times upon the case, in accordance with the practice of Roux, but with¬ out success. A narrow point of junction had been gained about the middle, which, by the movements of the sides, had become gradually elongated, so as to resemble a piece of thread, three-fourths of an inch in length, stretched between the two sides of the fissure. The cleft had originally been limited to the soft palate ; and, although the mar¬ gins had been three times pared, they still seemed sufficiently broad to sanction the hope of success from my own proceeding. On the 23rd of April, 1845, I operated; and the union was perfect throughout, with the exception of a small aperture in front, a little larger than might admit the point of a probe. In paring the edges, I left the transverse