Plastic surgery; its principles and practice . ng, until with thehelp of a skilled pediatrist the desired condition has been brought this way lives are certainly saved, and I attribute my very low mor-tality in harelip and cleft palate cases in some part to this , Brophy, Lane and a few other surgeons advocate operating on 26o PLASTIC SURGERY cases of cleft palate within a few hours after birth. My experience hasbeen that it is better to wait until the full benefit of the lip closure isobtained and the cleft is narrowed as far as possible. I prefer to oper-ate when the
Plastic surgery; its principles and practice . ng, until with thehelp of a skilled pediatrist the desired condition has been brought this way lives are certainly saved, and I attribute my very low mor-tality in harelip and cleft palate cases in some part to this , Brophy, Lane and a few other surgeons advocate operating on 26o PLASTIC SURGERY cases of cleft palate within a few hours after birth. My experience hasbeen that it is better to wait until the full benefit of the lip closure isobtained and the cleft is narrowed as far as possible. I prefer to oper-ate when the child is from eight to eighteen months old, and in myseries the results have seemed to justify the delay. Are We Justified in Operating on Adults with Harelip or CleftPalate?—There is no reason whatever why these older patients suffer-ing from one or both of these malformations cannot be operated onsuccessfully. Some of them have learned to speak distinctly, to singwell, and to eat solid food without difficulty. A successful closure of the. Fig. 221.—Method of narrowing a cleft by means of continuous elastic traction.(Sherman). The inner end of the plaster is placed on the cheeks just outside of the outer ends extend upward and outward as high as the top of the ear. Note the hooksand the elastic band in position. palate in these cases will probably cause little improvement in the speech,but closure of the lip, when associated with a complete cleft palate, willtransform a monstrosity into a fairly normal looking individual. Preliminary Care.—Nutrition should be brought to the higheststate. The child should become accustomed to being fed from aspoon, medicine dropper, or small glass syringe, since nursing, eitherfrom the bottle or breast should not be allowed for at least ten daysafter the operation. In older children adenoids, tonsils, and decayedteeth should be attended to before an operation for cleft palate. I con-sider it unwise to operate if the hemoglobin i
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