A manual of operative surgery . ventedby one man or another are legion, and to them must be addeda medley of lip-holders, palate-holders, suture-twisters, and thelike. The majority of these instruments are now fortunatelyobsolete. The surgeon should be able to work with simpleinstruments, and if he be unable to suture a cleft palate withoutan armoury of complex tools, he had probably better leave theoperation undone. 160 OPERATIONS ON HEAD AND NECK [part iff The following are the instruments required :—Two sharp-pointed tenotomy knives in long and slender handles, for paringthe edges of the cl
A manual of operative surgery . ventedby one man or another are legion, and to them must be addeda medley of lip-holders, palate-holders, suture-twisters, and thelike. The majority of these instruments are now fortunatelyobsolete. The surgeon should be able to work with simpleinstruments, and if he be unable to suture a cleft palate withoutan armoury of complex tools, he had probably better leave theoperation undone. 160 OPERATIONS ON HEAD AND NECK [part iff The following are the instruments required :—Two sharp-pointed tenotomy knives in long and slender handles, for paringthe edges of the cleft. A blunt-pointed knife of the same kind,for making lateral incisions to relieve tension. Two pairs oflong slender-bladed forceps, one serrated and one with tenaculumpoints. A pair of small sharp-pointed scissors curved to a quartercircle, for dividing the connection of the soft palate with the nasalmucous membrane at the posterior margin of the hard blunt-pointed scissors, curved on the flat, for the sutures,. FIG. 276.—DURHAMS CLEFT-PALATE RASPATORIES, WITH CLEFT-PALATE NEEDLECURVED RIGHT AND LEFT. etc. Two raspatories of different curves, such as are shown in , are necessary. They should be rather slender in make, as theycan then be used for operating on patients of various ages. Manyof the raspatories that have been devised are too heavy andclumsy. Different surgeons will prefer different forms of needle-holdersfor passing the sutures. Mr. Lane uses small curved needlesheld in a special holder. Another form frequently used is a slenderrectangular needle in one piece with the holder—the eye beingclose to the point. Many surgeons find needles twisted like a rams horn, set ina handle, and with an eye near the point, most convenient. CHAP. IV CLEFT PALATE 161 For introducing silkworm-gut sutures rapidly Fitzgeraldsneedles (Fig. 277) will be found useful. A loop of the gut is held in the needle, which has the slotdirected towards its point. The needl
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