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On harelip and cleft palate

INDEX.

Reading edition

A.

Accessory teeth in harelip, 54

Acquired apertures in palate, treatment of, 144

Adenoids in cleft palate, 71

question of removal of, 70, 104

Adults, harelip in, 69

After-treatment of harelip operations—

immediate, 85

mechanical and manual aids, 148

secondary operations for broad columna nasi, 148

V-notch, 147

After-treatment of palate operations—

educational, 150

for tension of velum, 149

immediate, 127

Age for harelip operations, 74

palate operations, 101

Albrecht, chief works of, 49

on accessory teeth in os incisivum, 54

on intermaxillary sutures, 27

on morphological position of alveolar harelip, 45, 48

Alveolar harelip, 3

dentition of, 51, 54

morphological position of, 48

Anæsthesia in cleft palate operations, 105

in harelip operations, 77

per rectum, 157

Animals, occurrence of deformities of, 10

Articulation, action of palate in, 35

defective after successful operation, 150

education required to improve, 150

in cleft palate, 69

Artificial vela, arguments for, 143

definition of, 139

objections to, 144

varieties of, 142

Assistant, duties of, in palate operations, 107

Atresia of nose, congenital, 14

Auricular appendages in macrostoma, 20

Author’s gag for operations on mouth, 109

incisions for double harelip operation, 98

single harelip operation, 81

B.

Bardeleben’s treatment of os incisivum, 94

Biondi on intermaxilla, 47

Blandin’s treatment of os incisivum, 94

Bony suture of palate, or osteoplasty, 133

Breadth of cleft palate diminished after closure of lip, 73

palate decreased after closure of cleft, 151

Breath, fœtid, in cleft palate, 71

Buccal cleft, or macrostoma, 19

Butcher’s treatment of os incisivum, 95

C.

Callender on intermaxilla, 46

Carless on intermaxillary sutures, 26

on intra-uterine cicatrix of lip, 5

on maternal shock, 25

Causes of congenital deformities, 23

Caustics in acquired deformities, 156

use of, after palatal operations, 132

Cheiloplastic operations for harelip, 91, 99

Classification of deformities of mouth, 1

Cleft palate, absence of uvula in, 9

action of muscles in, 64

arrangement of muscles in, 63

articulation in, 69

associated deformities, 11, 65

closed by facial flaps, 137

condition of pharynx in, 71

cranial deformities associated with, 65

development of, 59

effect of varying slope of segments, 65

feeding of patients with, 67

fœtid breath in, 71

frequency of, 9

functional results of, 67

influenced by closure of harelip, 73

moral effect of, 69

occurrence in animals, 10

operative treatment of (see Operative treatment of cleft palate)

pharyngeal complications, 71

slope of segments in, 9, 65

taste in, 71

uncommon varieties of, 8

varieties of, 5

vomer in, 6

width of, 9

Coles, nipple-shield for feeding infants with cleft palate, 68

on cranial deformities in cleft palate, 65

on size of normal palate, 32

Collis’s operation for unilateral harelip, 90

Collodion dressing for harelip, 84

Columna nasi, condition of, after bilateral operation, 146

secondary treatment of, 148

Condition of palate, immediate, after operation, 126

remote, after operation, 151

Cranial deformities in cleft palate, 65

D.

Davies-Colley, method of closing cleft palate, 134

Deformities associated with harelip and cleft palate, 11

of cranium in cleft palate, 65

of palate associated with mental dulness, 33

Deglutition, normal action of velum in, 34

Dentition in alveolar harelip, 51, 54

in facial clefts, 58

Desault on treatment of os incisivum, 93

Development of anterior nares, 41

of bones of skull, 42

of eyes, 38

of face, 37, 41

of intermaxilla, 43, 44

of mandible, 37

of mouth, 36

of nasal duct, 41

of nose, 39

of palate, 40, 43

of teeth, 43

of tongue, 41

Dieffenbach’s operation for unilateral harelip, 91

Division of levator palati by Fergusson’s method, 125

Pollock’s method, 126

Dog-nose, 15

Double harelip, median tubercle in, 61

operative treatment for (see Operative treatment for double harelip)

os incisivum in, 3, 62

Dressing for harelip operations, 84

E.

Edges, how to pare, in cleft palate, 120

Education of patients after palatal operations, 150

Ehrmann on change of shape of palate after uranoplasty, 151

on normal shape and size of palate, 32

statistics of early operations for cleft palate, 101

Endognathion, 27, 45

Exognathion, 27, 45

External nasal process, 39

its relation to the lip, 56, 57

Extirpation of os incisivum, 92

v. reposition, 96

F.

Facial cleft, 16

associated with harelip, 18

morphological position of, 57

varieties of, 17

Feeding of infants after harelip operations, 76, 85

with cleft palate before operation, 67

after operation, 128

Fergusson (Sir W.), loop-method of passing sutures, 121

method of dividing muscles in staphyloraphy, 125

on muscles in cleft palate, 63

on os incisivum, 62

osteoplasty, 133

Fissure of cheek (see Macrostoma), 19

lower lip (see Mandibular cleft), 21

palate (see Cleft palate), 5

upper lip, facial cleft, 16

harelip, 2, &c.

median harelip, 12

Fœtid breath in cleft palate, 71

Food, regurgitation of, in cleft palate, 67

Forceps for palate operations, 111

Franco on removal of os incisivum, 92

G.

Gag, author’s, in operations on the mouth, 109

Mason’s, 109

T. Smith’s, 108

Gensoul, forcible repression of os incisivum, 93

Gilis on intermaxilla in fœtus, 46

Giraldés’ or mortise operation for harelip, 88

Globular processes, 39

absence of, in median harelip, 58

Goethe on intermaxilla, 45

on morphological position of alveolar harelip, 45, 48

Graefe, operation for unilateral harelip, 86

H.

Hæmorrhage in palate operations, 117, 126

secondary, 132

Hainsby’s truss, 84

Hard palate, abnormal shape of, 33

function of, 34

history of operations upon, 115

measurements of, 32

mucous membrane of, 30

operative treatment of (see Operative treatment of cleft palate)

osteology of, 26

shape of, 32

after uranoplasty, 151

syphilitic disease of, 154

vascular supply to, 30

Harelip, action of labial muscles on, 60

ætiology of, 23

alveolar (q. v.), 3

anatomy of, 60

associated deformities, 11

causes of nasal deformity, 61

characters of, 2

condition of parents’ mouths in, 23

connections with maxillæ, 61

frequency of, 9

hereditary character of, 23

intra-uterine closure of, 5

maternal impression or shock in, 24

median (see Median harelip), 12

nose, shape of, in, 3

occurrence of, in animals, 10

operation for double, author’s, 98

Bardeleben’s, 94

Blandin’s, 94

Butcher’s, 95

Desault’s, 93

Franco’s, 92

Gensoul’s, 93

Langenbeck’s, 95

Sédillot’s, 99

T. Smith’s, 100

operation for single, author’s, 81

Collis’s, 90

Dieffenbach’s, 91

Giraldés’, 88

Graefe’s, 86

König’s, 89

Malgaigne’s, 87

Mirault’s, 89

Nélaton’s, 86

Stokes’s, 89

operative treatment for (see Operative, &c.)

double, 92

single, 77

percentage of, in different sexes, 4

Hare’s lip, characters of, 2

Heredity in harelip, 23

Hexaprodontous jaws, 27, 53

I.

Incisions in uranoplasty, 117

hæmorrhage from, 117, 126

lateral, in staphyloraphy, 126

secondary hæmorrhage from, 132

Instruments for palate operations, 108

Intermaxilla, absence of, in median harelip, 12

Albrecht on, 45

Biondi on development of, 47

Callender on, 46

development of, 39, 43, 44, 56

Gilis on development of, 46

Goethe on, 45

Intermaxillary sutures, number of, 27, 46

relations of, to alveolar harelip, 47

to facial cleft, 57

to median harelip, 58

Intra-uterine closure of harelip, 5

J.

Jaw, treatment of aperture after removal of upper, 145

K.

Kölliker on dentition in alveolar harelip, 52

König, operation for unilateral harelip, 89

L.

Langenbeck on condition of palate after operation, 151

operation of uranoplasty, 115

treatment of os incisivum, 95

Levator palati, description of, 28

division of, by Fergusson’s method, 125

by Pollock’s method, 126

function of, 29

Lip, compressors of, in harelip operations, 80

development of lower, 37, 58

of upper, 39, 56

underhung condition of lower, 147

use of collodion in depressing lower, 85

M.

Macrostoma, 19

auricular appendages in, 20

morphological cause of, 58

results of, 21

Malgaigne, operation for unilateral harelip, 87

Mandibular cleft, 21

morphological cause of, 58

Mason’s gag, 109

method for relieving tension of united velum, 149

modification in osteoplasty, 133

teat for infants with cleft palate, 67

Maternal impression or shock, 24

Mechanical and manual after-treatment of harelip operations, 148

Median harelip, 12

cerebral malformations in, 14

cranial defects in, 14

morphological cause of, 58

with intermaxilla absent, 12

with intermaxillary cleft, 14

Mental development in relation to shape of palate, 33

Mesognathion, 45

in alveolar harelip, 49

Mirault, operation for unilateral harelip, 89

Mouth, development of, 36

Muscles of soft palate, 28

division of, in staphyloraphy, 125, 126

N.

Nasal twang in cleft palate, 69

causes of persistence of, after operation, 150

Needles for palate operations, 112

Nélaton’s operation for unilateral harelip, 86

use of, for recurrent V-notches, 147

Nesbitt on palatal sutures, 45

Nipple-shield for infants with cleft palate, 68

Nose, development of, 39

shape of, in harelip, 3

shape of, in harelip, cause of, 61

shape of, in median harelip, 13, 14

Nutrition, difficulty of, in cleft palate, 67

O.

Obturators, arguments in favour of, 143

characters of recent, 141

definition of, 139

for acquired apertures, 144

objections to, 144

review of history of, 140

use of, 144

Operative treatment by facial flaps, 137

of acquired apertures of palate, unsatisfactory character of, 156

Operative treatment of cleft palate—

after-complications, 129

after-treatment, 127

anæsthesia, 105

anterior part of cleft, treatment of, 135

assistant’s duties, 107

condition of palate after, 151

education of patient after, 150

facial flaps employed for, 137

hæmorrhage in, immediate, 117, 126

secondary, 132

history of, 115

instruments for, 108

osteoplasty, 133

period for, 101

position of patient in, 104

preparation of patient, 103

shape of palate after, 151

staphyloraphy, 126

superiority of, to mechanical appliances, 144

sutures, materials employed for, 113

methods of passing, 121, 123

period for removal of, 129

typical result, 149

uranoplasty, 115

Operative treatment of harelip—

after-treatment, 85

anæsthesia, 77

detachment of lip from maxilla, 78

dressing employed, 84

effect of, on width of palatal cleft, 73

feeding of infant after, 76, 85

formation of prolabium, 79

Hainsby’s truss, 84

lip compressors in, 80

period for, 72

pins, use of, in, 81

position of patient, 77

preparation for, 76

prevention of V-notch, 79

stages of, 77

statistics of, 74

suturing lip, method of, 83

typical result, 79, 146

V-notch after, 147

Operative treatment of double harelip (see Harelip, operations for double)—

of labial tissues, 98

of os incisivum (q. v.), 92

usual result of, 147

Operative treatment of single harelip (see Harelip, operations for single)

Os incisivum, dentition of, 54, 62

description of, 61

position of, in double harelip, 3

Os incisivum, treatment of—

extirpation (Franco), 92

extirpation v. reposition, 95

fixation of, after reposition, 95

forcible repression (Gensoul), 93

gradual repression (Desault), 93

reposition after division of septum (Blandin, Bardeleben, Butcher), 94

Osteoplasty, Fergusson’s operation, 133

Mason’s modification, 133

reasons for discontinuance, 133

P.

Palate, acquired apertures in, 144, 154

cleft (see Cleft palate)

development of, 40, 43

hard (see Hard palate)

processes, 40

soft (see Soft palate)

Passavant on narrowing of cleft palate, 73

Period for operation on cleft palate, 101

on harelip, 72

Philtrum, 62

treatment of, 98

Phonation in cleft palate, 35

Pins, use of, in harelip, 81

Pollock, method of dividing levator, 126

on cleft palate, 64

Position of patient in operation for cleft palate, 104

for harelip, 77

Preparation of patient in operations for cleft palate, 103

for harelip, 76

Prevention of V-notch, 79

Prolabium, formation of, 79

R.

Raspatories for palate operations, 110

Reposition of os incisivum (see Os incisivum), 93

Rose (E.), position in palate operations, 104

Rose (W.), gag, 109

operation for double harelip, 98

single harelip, 81

S.

Secondary operation for closing fistulas in palate, 131

prominence of lower lip, 97, 148

reducing size of columna, 148

tension of united velum, 149

V-notches, 147

possibility of, after sloughing, 138

Sédillot, operation for double harelip, 99

Shape of hard palate, after uranoplasty, 151

normal, 32

Smith (T.), direct method of suturing palate, 123

gag, 108

modification of uranoplasty, 134

needle for palate operations, 124

operation for double harelip, 100

Soft palate, functions of, 34

muscles of, 28

methods of division of, 125, 126

vascular supply of, 31

Stages in operation for cleft palate, 116

harelip, 77

Staphylo-pharyngoraphy, 137

Staphyloplasty, 137

Staphyloraphy, 126

Statistics of early operations for cleft palate, unfavorable, 101

operations for harelip, 74

Stokes’s operation for single harelip, 89

Sutton on median harelip, 13

Sutures, direct method of passing, 123

loop-method of passing, 121

materials employed for, in lip operations, 83

in palatal operations, 113

method employed for adjusting, in double harelip, 99

single harelip, 83

period of removal of, after lip operations, 84

after palate operations, 129

Syphilitic affections of hard palate, 156

velum, 155

treatment of, 156

T.

Taste, improvement of, after closure of cleft palate, 150

in cleft palate, 71

Tertiary syphilitic affections of palate, 156

Tonsils, enlargement of, in cleft palate, 70

treatment of, 103

Typical result after operation for cleft palate, 149

harelip, 146

U.

Underhung lip after removal of os incisivum, 96, 147, 148

Uranoplasty (see Operative treatment for cleft palate)

description of, 116

effect of, on shape of palate, 151

history of, 115

Uvula, absence of, 9

fissure of, 8

method of suturing, 123

muscles of, 29

V.

Velum palati (see Soft palate)

V-notches in lip margin after operation, 79

treatment of, 147

Voice, causes of non-improvement in, after operation, 150

characters of, in cleft palate, 69

education of, necessary, 150

Vomer, condition of, in double harelip, 6, 63

development of, 41, 43

position of, in cleft palate, 6

treatment of, in double harelip, 93

use of mucous membrane over, 134

W.

Warner on association of mental dulness, &c. with deformed palates, 33

Wolf-jaw (Ger. Wolfsrachen), 3, 6

Wolff’s artificial velum, 143

Wölfler on mandibular clefts, 58

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