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.

    16/20 (page 16)
    My friend and former pupil, Mr. Robert R. Storks, lias given me tlie following interesting narrative :— Case xix. “ M. J., set. 20, applied to me in June, 1846, for relief from congenital fissure of the soft palate, ■which, on examination, pre¬ sented the following appearances : —The fissure extended directly in the mesial line, from the posterior edge of the horizontal plates of the palate bones to the extremity of the uvula, which was divided into two nearly symmetrical halves. The flaps on either side were ample, and during deglutition lay almost in apposition, but, on irritating the fauces, they were drawn powerfully upwards and outwards, and were with diffi¬ culty distinguished from the surrounding mucous membrane. Her articulation was very imperfect; and, during mastication, particles of food passed into the posterior nares, occasioning great distress. On June 21st, Staphyloraphy, after the method recommended by Mr. Fergusson, was performed, the levator palati on each side being divided. After the division of these muscles, the flaps were nearly in apposition, although there had been considerable loss of substance from the paring of the edges of the fissure ; nor could I excite, on either side, any con¬ traction by irritating the parts with the finger. As no other muscular fibres appeared in this case to exercise any influence opposed to the union of the parts, I did not interfere with either the palato-glossi or palato-pharyngei muscles. Four stitches were required to bring the parts together; one of which I removed on the second, the remaining three on the third day, after the operation. Beef tea and wine were allowed after the first twenty-four hours had elapsed. On the fourth day she had a severe attack of sore throat, accompanied with ulceration and erythematous redness over the palate ; on the fifth day it was sub¬ siding ; and it was, after a week, difficult to say that an operation had ever been performed. It would be out of place for me to make any observations upon the case here narrated; but I cannot refrain from bearing my unbiassed testimony in favour of the views laid before the profession by Mr. Fergusson, in the Medico-Chirurgical Transactions. Having had opportunities of witnessing the performance of the old operation, in the hands of some of the most eminent surgeons of the day, including its originator, M. Roux; and subsequently, through the kindness of Mr. Fergusson, having examined his preparation and assisted him in many of his operations, I cannot too strongly express the opinion, that in my humble judgment, the relief of the lamentable deficiency it is proposed to remedy, is, by the latter proceeding (assum¬ ing that the soft parts are sufficiently ample to meet in the mesial line), rendered as certain of success as the operation for hare-lip. The pas¬ sive condition to which the parts are reduced, by the division of the muscular fibres, the effusion of lymph above the palate, acting as a splint and rendering motion impracticable, combined with the greater amplitude given to the soft parts by the partial and temporary destruc¬ tion of their arched form, may be enumerated as perhaps the principal advantages of this proceeding. In addition, the paralyzed condition of the. muscles influencing the wound, enables the surgeon to allow the patient food at a much earlier period than after the old operation,—a matter of no slight importance in some constitutions. Two things are essentially necessary before any individual is competent to give an