Fissure of the soft and hard palate / [Jonathan Mason Warren].

  • Warren, Jonathan Mason, 1811-1867.
Date:
1848?]
Catalogue details

Licence: Public Domain Mark

Credit: Fissure of the soft and hard palate / [Jonathan Mason Warren]. Source: Wellcome Collection.

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    -a day from the time of the operation. The stitches: were removed on the third or fourth day, and the union found to be perfect, so as to oblit- erate about two-thirds of the whole fissure. I then referred her to Dr. . ‘Tucker, who constructed an obturator which closed up the remaining aperture in the bones, and enabled her at once to articulate with much greater distinctness than ever before. Casz II—1846, Sept. 26th, W. E., aged 18, was operated on for a congenital fissure of the soft and hard palate, the latter being separated half an inch. ‘The membrane was dissected from the hard -palate, and _the posterior pillar divided, when the two sides hung almost perfectly flac- cid. A strip was next removed by the curved scissors, from the whole margin of the fissure.’ The edges were approximated by four sutures. There was but little bleeding, and, to prevent oozing, iced water was or- dered for the rest of the day. 29th. ‘“ He has not had a bad symptom; no cough, no soreness of the _throat ; he has been able to sit up, and to-day is down stairs. 1 removed the stitches, and the union appeared to be perfect.” A small aperture, however, in a few days presented itself at the upper angle of the fissure. But this did not prevent him from returning home on Oct. 3d. The aperture was touched occasionally with the nitrate of silver, and by Nov. 17th was obliterated. His voice had greatly improved. Case 1V.—Miss A. G., aged 22, with a congenital fissure of the soft and hard palate, extending through the ossa_ palati, was operated on in the usual manner, Oct. 8th, 1846, Drs. Parkman and Briggs assisting. The bleeding was rather more than usual, and required the constant use of the sponge, in order to allow of the prosecution of the different steps of the operation. She was directed to keep small bits of ice in her mouth for the remainder of the day. “9th. Has had a comfortable night. “11th. The wound has an appearance as if about to suppurate:” and, in fact, on the following day, the stitches seemed ready to give way. An additional suture was, therefore, immediately taken at the lower part of the fissure. . A. small portion of the wound united at the upper part at once, and still more from the additional stitch. By the occasional use of caustic and scarifications, the whole fissure, with the exception of an aperture at the inferior part of the soft palate, was closed. ‘This latter, made by the ulceration of one of the ligatures, was quite manageable. This patient was healthy, and kept uncommonly quiet. The disposi- tion to suppurate in the edges of the flaps seems to have arisen from the too free use of the sponge, which I discovered afterwards was of bad quality, and quite filled with sand. This serves to show how trifling a matter may defeat the best planned operation, as in this case I had ex- pected a most perfect union by the first intention. _ [have lately seen this lady, and find the new palate to be very flex- ible ; her speech is also much improved, and she is daily icreasmg in her command of it. Cast V.—Hannah H |* b) , aged 20, had a congenital fissure of the