Other less common congenital deformities have been recorded, and amongst
them may be noted a case lately seen by myself in a girl of four years,
in whom there existed an oval opening at the junction of the hard and
soft palate, separated by a narrow bridge of normal palatal tissue from a
cleft of the posterior half of the velum and uvula, showing intermissions
of development; a congenital aperture in the soft palate at its junction
with the hard, or in any part of the velum, but with no defect of either
uvula or palate bones (Dieffenbach[4]); a defective development of the
palate bones alone, the mucous membrane remaining intact from side to
side, and hence no cleft resulting (Trélat, Notta, Langenbeck); or again,
as in Fig. 15, a cleft only of the anterior portion of the palate,
extending through the alveolus, and for a short distance behind it
(Mason[5]). Inasmuch as the union of the two halves of the velum occurs
subsequently to that of the alveolar arch, it appears that this last
rare defect must have been due to an intermission of development, which
was felt only at the anterior portion, whilst that of the posterior part
proceeded normally at a later date.
Mason[6] records a curious case worth mentioning of a girl under his
care in 1877, who had a fissure extending through the velum, and for a
short distance into the hard palate, but there was no trace of uvula on
either side, and the soft palate was continuous on both sides with the
pharyngeal wall.
The width of the cleft varies as much as the extent, and is a matter of
great importance prognostically, as the broader clefts are much more
difficult to close. The direction or slope of the segments of the bony
palate also differs considerably, in some instances being more or less
horizontal and following the normal curve; in others one or both of the
segments is much more nearly vertical, a condition which is not at all
unsatisfactory, for, as will be explained hereafter, the more horizontal
the palatal processes, the more difficult is it to gain satisfactory
closure by operation (p. 65).
* * * * *
The frequency of the occurrence of harelip and cleft palate cannot
accurately be ascertained, inasmuch as statistics are not readily to be
found. In the ‘St. Thomas’s Hospital Reports’ the number of malformations
of the children born is noted in some of the years. Thus the aggregate
number of living children born in their maternity department in the years
1875, 1877-1880, and 1883 was 10,653, and of this number there was only
one case of harelip, with two cases of cleft palate, and three of the
combined deformity, _i. e._ about one case in every 1800 infants born;
but if the silence of the reports for subsequent years means absence of
deformity, then this proportion may be much too great.
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