340 ILLINOIS STATE ACADEMY OP SCIENCE 



of the maxillae are drawn together the posterior ends, 

 aided by the upward pressure of the mandible, move 

 apart. 



Unless steps are taken in early infancy to prevent the 

 tuberosities from spreading (which is accomplished by 

 the use of wires not only anteriorly but posteriorly), the 

 bones will separate widely and the palate will be short- 

 ened to such an extent that perfect speech will seldom be 

 secured. When the tuberosities are abnormally separ- 

 ated the soft palate, when united, will be put on the 

 stretch and consequently shortened so that it cannot 

 reach the post-pharyngeal wall; it will be like a drum- 

 head, without flexibility or resilience. If lateral incisions 

 are made through the soft palate in an attempt to relieve 

 tension, a great mass of cicatricial tissue will result 

 which makes it thick, unwieldly and inflexible. 



The horizontal plates of the palate bones are elevated; 

 the tuberosities are widely separated; consequently the 

 hemispheres of the soft palate are also widely separated. 

 The soft palate may be to some extent atrophied for 

 want of normal use, but the width of the cleft is not due 

 so much to atrophy as to the malposition of the parts. 



It must be remembered that lateral incisions oftentimes 

 divide the fibers of the tensor palati-muscle, which has a 

 two-fold function — to make tension on the palate and to 

 dilate the pharyngeal orifice of the Eustachian tube. The 

 division of this muscle leads to early defective hearing, 

 due to the destruction of the continuity of the muscle and 

 consequent failure of the normal dilation of the pharyn- 

 geal orifice of the Eustachian tube. When introducing 

 the posterior wire in operating on the soft palate, it 

 should be passed as nearly as possible through the center 

 of the tensor palati muscle as it swings around the hamu- 

 lar process, thus suspending the contraction of the muscle 

 until the hemispheres of the palate unite. 



I regret that I have not time to discuss the treatment 

 of the defective lip and nose, for this phase of plastic sur- 

 gery is most important in rounding out the work of mak- 

 ing normal these patients who come in such distressing 

 condition. But what does it avail, to produce the most 

 careful and painstaking operation on the lip, if under- 



