Journal of the New Zealand Medical Association, 09-September-2011, Vol 124 No 1342
On a New Method of Treating Cleft Palate: part 2
From article written by HP Pickerill, MD, MDS, published in NZMJ May 1912;11(42):125–130. (continued from part 1 at http://journal.nzma.org.nz/journal/124-1341/4857)
It seems a little strange that an operation which is objectionable from a dental point of view should should have been devised and practised by a professor of dental surgery.
Methods of Class II are divisible into two varieties, those closing the cleft with the patient's tissues, i.e., by a flap operation, and those closing the cleft with artificial tissues, i.e., a mechanical appliance. Examples of flap operations are the Davis Colley and the Arbuthnot Lane operations.
THE DAVIS-COLLEY operation merely deals with the hard palate, which is the least important part. The soft palate remains to be closed, otherwise, and moreover the closure of the hard palate is rarely complete.
LANE'S FLAP OPERATIONS provide fresh tissue by raising flaps from the palatal and nasal surfaces of the velum and turning them respectively upwards and downwards and sutering them together. The idea is eminently rational and should yield good results. It is, unfortunately, a severe operation and the mortality is comparatively high, though there seems to be a consensus of opinion that Mr. Lane's advocacy of the operation in the first few days of life is open to serious objection, The method of closing the posterior part of the palate before the lip is, I think, good if only for the reason that more room is afforded.
MECHANICAL APPLIANCES are of two varieties—the obturator and the artificial velum; both of which are attached to dental plates which cover the hard palate and thus fill up any deficiency there. The obturator is a solid or hollow mass of rigid vulcanite completely filling up the cleft. An artificial velum is constructed of soft rubber which is deeply grooved laterally to fit the margins of the cleft, and is attached by means of a hinge or spring to the denture.
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