. Transactions of the Southern Surgical and Gynecological Association . raised from the bonesin the following manner: Place the forefinger of the left handon the hamular process; take a short, strong, slightly curved,narrow-bladed knife, and make a curvilinear incision on oneside, beginning just behind the hamular process, cuttingdown to the bone and extending the incision forward alongthe alveolar process as far as desired. Prevent hemorrhage HARELIP AND CLEFT PALATE by pressure of the finger and gauze, raise the mucoperiostea]flap rapidly with a strong periostea] elevator from the segment of
. Transactions of the Southern Surgical and Gynecological Association . raised from the bonesin the following manner: Place the forefinger of the left handon the hamular process; take a short, strong, slightly curved,narrow-bladed knife, and make a curvilinear incision on oneside, beginning just behind the hamular process, cuttingdown to the bone and extending the incision forward alongthe alveolar process as far as desired. Prevent hemorrhage HARELIP AND CLEFT PALATE by pressure of the finger and gauze, raise the mucoperiostea]flap rapidly with a strong periostea] elevator from the segment of the hard palate, and immediately pack the wound firmlywith Iodoform or formalin gauze. Repeat this performance on the opposite side, and then tie the horse-hair stitches notalready secured. It will then he seen that the soft structuresof the hard and of the soft palate are now beautifully held inapposition without tension on the stitches. The periosteumis freely separated from the palate hone, especially fromits position border. In packing the gauze into the wound,. Fig. 9.—Lanes cleft-palate operation. Flaps brought down andapproximated to close cleft. fixation points are obtained by forcing some of it into thebone, also between the teeth and under the mucous mem-brane. If this is carried out properly the gauze will remain inplace for a week, and sometimes longer. It is removed whenit becomes loosened, and, occasionally, a third packing mayhave to be inserted. The packing prevents bleeding, relievesthe tension of the palate, and prevents the occurrence ofsepsis for the first week after operation. It will be observed that this is not a flap-splitting, but aflap-formation operation, the flaps carrying with them two ALEX. HUGH FERGUSON 293 narrow strips of the firm, strong, buccal mucous membraneof the palate. They are held in coaptation by means of suturesinserted on the buccal surface. An ideal protecting roof tothe raw surfaces beneath them is afforded; twice the width ofde
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