EXCMNG CAUSES OF CLEFT PALATE.
In early intra-uterine life, be tween the second and third months, the tongue is much thicker than at birth. It occupies a great deal of space between the developing bony plates of the palate, and may interfere with the bones meeting and uniting.
At the third month the muscles of mastica tion become active and the mandible brings pressure on the soft, flexible un-united bones of the palate and, acting as a wedge, mechani cally forces them further apart, thus widening the breach.
If an examination be made of a young child with a complete cleft palate, it will be noticed that the upper alveolar ridge is outside of the lower ridge. The upper arch is, therefore, spread by the wedge formed by the lower jaw,.
The normal position of the fcetus in utero is such that the weight of the entire fcetal body may be readily thrown upon the vertex and the pressure thus exerted would tend to force the mandible into contact with the sternal region and compress it against the forming hard palate. The flexed position of the head, with the symphysis of the mandible resting on the sternum, may contribute to some extent to the force which is exerted by the mandible. It is generally accepted that the lower jaw acts as a matrix or mold upon which the upper jaw is formed.
Treatment of Cleft Palate.— The object to be attained in operating on cleft palate and harelip is not only to overcome the visible de formity, but to ensure, as nearly as possible, correct phonation.
The importance of the palate as an organ of speech is often overlooked, and the follow ing quotation from the late Dr. G. Hudson Makuen, noted author on voice-production, shows the necessity of a normal palate for perfect phonation: " There is a popular notion that the tongue is the chief organ of speech arid that the sense of taste Is located in the pale°. Both the palate and the tongue are important organs of epsech, but the former is more so, for not only is it essential m the enunciation of nearly all the elements of speech, but. ovring to its direct attachment to the larynx,
tt is also an important factor in the production of voice. The vowel sounds may be articulated when the palate is defective. but their resonance is so much impaired that they are scarcely recognizable. and their pitch cannot be changed with any degree of accuracy. It as in the articulation of consonant, sounds. however, that the palate is especially essential.' When to Operate.—The time to treat a deft palate is as early after birth as possible, preferably within the first month, when the separated bones of a cleft palate should be closed.
Palate Surgery is Bone A palate can never be normal unless the bones are united. Bone surgery, therefore, is necessary when the bones of the hard palate and the alveolar process are separated.
Steps in steps are called for: (1) The bones should be united and the/ nose placed in its normal position. (2) The should be closed, usually about four weeks after the bone operation. (3) Finally, the soft palate should be closed so that the patient, when becoming old enough to speak, will speak dis tinctly. This is done about the 14th month.
The cleft should be closed before ossification of the bones is far advanced, while they may be bent and moved without fracture. Bone at birth is about one-half organic matter, hence it is not difficult to bend the bones and close the cleft a few days after birth. Protruding pre-maxillary bones should never be removed, but should be fixed in the arch and held firmly in place until they unite with the maxillary bones and complete the arch.
The highest degree of success in the treat ment of cleft palate is obtained by operatin.g in early infancy, at which time the operation is more safely performed, but successful operation may be made at any. time in life. If the patient has a harelip only, it may be operated upon at any time.