SURCxERY. 213 



figure-of-eiglit suture is the one most usually employed, and for this reason 

 frequently called hare-lip suture. The shape and size of the needles vary 

 greatly. Dieffenbach made use of fine insect needles or pins, which, after 

 being properly wra]iped, are cut off close to the thread. Two needles 

 usually suffice for children, three for adults. Fl. 189, fig. 18, ah c^ shows 

 the mode of introducing the needles. As soon as a needle is inserted, it is 

 wrapped with thread and fastened, and a common thread may finally be 

 wound over all the needles {fig. 19). Should the lip be much drawn up or 

 shortened, circular incisions may be made on each side, as shown in fig. 

 20, a h. 



7. Cleft Palate. 



A fissure of the palate is frequently found associated with hare-lip : it may 

 be a congenital disease, or the result of injuries or diseases of after-life. 

 Like hare-lip, too, it is an arrest of development which prevents the corre- 

 sponding lateral portion of the palate from uniting along the median line to 

 form a continuous roof to the mouth. 



Formerly it was the custom in such cases to supply an artificial roof to 

 the mouth by means of a plate of gold, silver, horn, &c. This answered 

 more or less satisfactorily for fissures of the hard or bony palate, while 

 fissures of tlie soft palate were, until quite recently, considered irremediable 

 and incurable. The operation of suture of the palate, better known as 

 siaphylorapliia^ was first attempted by Griefe in 1816. This consisted in 

 paring off the edges of the fissure, which were afterwards brought into such 

 approximation that the sides united perfectly. Experience, too, has showii 

 that the operation not only obliterates the fissure in the soft palate, but ulti- 

 mately that in the hard palate likewise. 



A piece of cork is required to be placed between the back teeth, for the 

 purpose of keeping the mouth open during the operation. Different kinds 

 of knives have been made use of to pare the edge of the fissure, as also 

 various forceps and tenacula for arranging the edges. Ligatures of about 

 two feet in length are necessary. Various forms of needles, needle-holders, 

 and forceps are required for making the attachment, and special instruments 

 are required for tying the knots. 



The operation is conducted as follows: The mouth of the patient is 

 opened, and the base of the tongue depressed. With a knife, having a blade 

 somewhat like the edge of a lancet, the cutting edge about a quarter of an 

 inch in extent, and the flat surface bent semicircularly. an incision is 

 made about half an inch long on each side of the posterior narss, a little 

 above and parallel to the palatine flaps, and across a line straight down- 

 Avards from the lower opening of the Eustachian tube, by which the levator 

 palati is divided on both sides, just above its attachment to the palate. The 

 edges of the fissure are next pared with a straight blunt-pointed bistoury, 

 removing little more than the mucous membrane; then, with a pair of long, 

 blunt-pointed, curved scissors, the posterior pillars of the fauces are divided 



919 



