Identifier: operativesurgery00brya (find matches)
Title: Operative surgery
Year: 1905 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914
Subjects: Surgery, Operative Surgery, Operative
Publisher: New York : D. Appleton
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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e and inflammatory action to subside, and to determinemore clearly whether further section will be required. The levator muscle,if it be made tense by drawing the velum toward the incisor teeth by meansof the silken thread, may be cut with blunt scissors under direct observation,especially if the cleft be deep. The Operation of Staphylorrhaphy.—There are three steps to the opera-tion of staphylorrhaphy: 1. Freshening the edges of the cleft. 2. Passingthe sutures. 3. Coaptating the divided borders and tying the sutures.First apply a solution of cocaine to the palate, if advisable, and then,placing the patient in a chair or on a table which will permit the head to bethrown well back so as to expose the parts to a strong light, insert the gagand draw the cheeks aside (Fig. 798). The lower point of one border of thecleft is then seized with the forceps, made tense, and the border freshenedfrom below upward (Fig. 799), or thereverse if desired. Treat the oppositeside in a similar manner.
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Fig. 799. Fig. 798. Fig. 798.—Whiteheads mouth gag.Pig. 799.—Freshening the borders of the cleft. Cheeks drawn aside by elastic traction.Sutures supported by hooks on band around head. If an ansesthetic has not been employed, the patient is allowed to restafter the completion of the first step, until the hgemorrhage ceases and self-control is regained. The sutures should be half a yard in length, doubledbefore passing, and thoroughly aseptic. Either horsehair, silkworm-gut, ormetallic sutures can be employed. Three or four are usually sufficient.The first should be introduced at the middle, the second at the lower ex-tremity, of the gap, while the remaining ones close the spaces between. Theycan be passed from before backward on one side, and from behind forwardon the other, by means of the needle holder and the ordinary short-curvedneedle (Fig. 800), or in the following manner by means of a curved needlewith the eye near the point (Fig. 79-1, c). Seize the left side of the cleftw

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