338 ILLINOIS STATE ACADEMY OF SCIENCE 



cess in palatal surgery. The surgeon must have always 

 in mind the goal of correct speech and he must know how 

 that speech is attained by normal organs so that he may 

 use every means to conserve and build up a normal mech- 

 anism from the defective parts which he finds in a cleft 

 palate. 



All surgery of cleft palate should have for its ultimate 

 object perfect function, which is perfect speech. The 

 test of success is the quality of enunciation resulting. 

 Two phases of palatal surgery have especially to do with 

 this : the union of the separated bones of the palate, in- 

 cluding the management of the premaxillae; and the 

 control of the tuberosities in their relation to the soft 

 palate. Without a proper conception and execution of 

 these fundamentals in palatal surgery, there is small 

 hope of securing satisfactory form or function. I wish 

 today to emphasize the control of the tuberosities. 



I present to you briefly the course which I am con- 

 vinced gives the nearest approach to normal form and 

 function in the palate. That course provides for opera- 

 tion in early infancy; it contemplates the establishment 

 of a "normal palatal arch and the prevention of the 

 spreading of the tuberosities ; it calls for three stages in 

 the treatment of typical double cleft of the lip and palate, 

 and sometimes four, if complicated by protruding pre- 

 maxillae. These stages are as follows: 



1st. The freshening, approximation and immobiliza- 

 tion of the cleft bones so that union may take place. 



2nd. The closure of the lip. 



3rd. Operation upon the soft palate. 



4th. Elevating the nose which may have become flat- 

 tened by the moving backward of the premaxillae. 



The first step should be taken as soon after birth as ex- 

 pedient, — the 4th to 10th week, or after the functions of 

 the body have become well established. 



The second step, the closing of the lip, should be done 

 in from 6 to 10 weeks after the union of the bones. 



The third step, the closing of the soft palate, should be 

 deferred until just before speech is attempted, usually 

 about the 18th month. 



The fourth step is to elevate the nose, if necessary. 



