SURGERY. 213 
figure-of-eight 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 wrapped, are cut off close to the thread. ‘T'wo needles 
usually suffice for children, three for adults. Pl. 189, jig. 18, a 6 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 (jig. 19). Should the lip be much drawn up or 
shortened, circular incisions may be made on each side, as shown in fig. 
20, a b. 
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, &e. This answered 
more or less satisfactorily for fissures of the hard or bony palate, while 
fissures of the soft palate were, until quite recently, considered irremediable 
and incurable. The operation of suture of the palate, better known as 
staphyloraphia, was first attempted by Grefe 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 shown 
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 iancet, 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 nares, a little 
above and parallel to the palatine flaps, and across a line straight down- 
wards 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 
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