white's hair-lip and cleft palate operation 473 



hair-lip the operation is performed only for cosmetic pur- 

 poses, but when combined with cleft palate the operation is 

 a necessity because the impaired power of prehension inter- 

 feres with pruper nourishment and at once leads to mal- 

 nutrition and non-development. 



There are several varieties of the deformity: — (i) Sim- 

 ple, uncomplicated hair-lip, unilateral, medium or bilateral; 

 (2) Hair-4ip, unilateral or bilateral, complicated with single 

 or double cleft palate. Of these the cleft may be complete 

 or incomplete, anterior and posterior, wide or narrow. The 

 deformity to which these varieties belong sometimes extends 

 upward to the eye and backward through the velum. It is 

 only the simplest forms of hair-lip and cleft palate that are 

 amendable by surgical treatment in animals. The veterinar- 

 ian is not expected to interfere with the complicated forms 

 because the complexity of the procedure is out of proportion 

 to the value of the individual affected. Notwithstanding 

 the fact, however, that these operations have never been ex- 

 tensively attempted in the history of veterinary surgery, 

 the author coincides with White's opinion that the possi- 

 bilities are as wide and the general results as good in pups as 

 similar operations amongst babies. 



TECHNIQUE.— The deformity involves the skin, 

 mucous membrane, periosteum and bone, constituting the 

 lip, alveolar processes, palatine process of the superior max- 

 ima, and -the hard palate. The operation involves denuda- 

 tion, relaxation, coaptation and retention, of these structures 

 and each of these processes must vary according to the char- 

 acter of the deformation. 



First Step — Denudation. — In making raw edges to unite 

 with sutures, strict economy of tissue must be practiced 

 because there is never any tissue to spare, and when the fis- 

 sure is a wide one it may tax the ingenuity to construct a 

 covering for it. In babies it is sometimes found necessary 

 to perform two, or even three, consecutive "crowding" oper- 

 ations to effect a complete closure,' hence the advisability of 

 saving all the tissues in denuding the border for coaptation. 

 Marginal incisions are made along the borders of the cleft 

 through the skin in the lip and through the mucous mem- 

 brane and periosteum in the palate. These incisions are 

 lifted up into flaps that can be sutured. 



Second Step — Relaxation. — In the lip two lateral incisions 

 are made through the skin some little distance from the de- 

 nuded margin; or, if the fissure is wide, the cheek may be 

 detached from the bone to allow the lip structure to be 



