Operations for fissure of the soft and hard palate, with the result of twenty-four cases (pp.328-338).

Warren, Jonathan Mason

Published by Publication Date: 1848

Am. J. Med. Sc., n.s., 15. - Philadelphia: Lea & Blancard; London: Wiley & Putnam, and John Miller, 1848, 8°, 584 pp., 3 lith. Taf., Pappband; fleckig. First Edition! "While studying in Europe, Jonathan Masson Warren (1811-1867) witnessed Philibert Roux (1780-1854) perform his operation for cleft palate repair. He later drew on this first-hand knowledge when devising his own operation for the repair of cleft palate. His closure of complete clefts of the palate went an important step beyond what he had witnessed in Europe, where only soft palate defects were corrected, and represented a great improvement over the primitive uranoplasty of Johann Dieffenbach (1792-1847). Between 1840-60, Warren was probably the most skilled surgeon in the world in closing the complete cleft palate. Many patients from all parts of America were referred to him, and he is known to have surgically treated over one hundred clefts. In the third paper Warren summarized his experience, noting that ninety percent of the clefts that he saw were complete. He always avoided the use of general anesthesia because of danger to the unconscious patient from "the constant flow of blood down the throat." Since he had to depend upon the cooperation of a conscious patient, he deferred palatoplasty until the patient was at least six years old. Warren discovered that it was easier and better to peel the soft tissues bluntly up off the oral surface of the palatine bones, rather than to attempt to dissect the mucosa. He routinely used a lateral incision extending back across the anterior pillar, and even the posterior pillar when necessary. Warren was the first to develop each side of the palate into a loose and relaxed flap that could easily be shifted to meet the other side. His success rate in the closure of complete cleft palate was estimated to have been more than ninety percent; however, he continued to recognize the difficulty in mobilizing the area near the connection of the soft palate with the palatine bones. For handling postoperative fistulae, Warren applied a caustic (cantharide, silver nitrate, sulphuric acid), and inserted an obturator or a simple prosthesis. He wrote that "two portions of Goodyear's patent India-rubber may be cut a little larger than the aperture to be closed; they are stitched together in the center: one portion is slipped into the nasal aperture, it keeps the second in the mouth in place. It can be removed and replaced at the pleasure of the wearer." Rutkow PSp18-20 Rutkow PSp19. Seller Inventory # 65911

Bibliographic Details

Title: Operations for fissure of the soft and hard ...
Publication Date: 1848
Binding: Hardcover
Edition: 1st Edition