Of the HARE LIP.
THIS Disease is a Fissure in the Upper Lip, with want of Substance, and is a natural Defect, the Patient being always born with it, at least that Species of Hare Lip which requires the Operation I am going to describe. The Cure is to be performed by the twisted Suture, the Explanation of which I have reserved for this Chapter. There are many Lips, where the Loss of Substance is so great, that the Edges of the Fissure cannot be brought together, or at best where they can but just touch, in which case it need not be advised to forbear the Attempt: It is likewise forbidden in Infants, and with Reason, if they suck; but otherwise it may be undertaken with great Safety, and even with more probability of Success, than in others that are older, as I have myself experienced.
It is not uncommon for the Roof of the Mouth to be fissured likewise; but this is no Objection to the Operation, if the Skin of the Lip is loose enough to admit of Reunion: and it may be remarked, that the Fissure of the Palate, in length of Years, closes surprisingly in some Cases.
The Manner of doing it is this. You first with a Knife separate the Lip from the Upper jaw, by dividing the Frænulum between it and the Gums; and if the Dentes Incisorii project, as is usual in Infants, they must be cut out with the same Knife; then with a thin pair of straight Scissars take off the callous Edges of the Fissure the whole Length of it, observing the Rule of making the new Wound in straight Lines, because the Sides of it can never be made to correspond without this Caution.
For instance, if the Hare Lip had this Shape, the Incision of the Edges must be continued in straight Lines still they meet in the manner here represented. The two Lips of the Wound being brought exactly together, you pass a couple of Pins, one pretty near the Top, and the other as near the Bottom, thro' the Middle of both Edges of it, and secure them in that Situation, by twisting a Piece of waxed Thread cross and round the Pins seven or eight times; you must then cut off the Points, and lay a small Bolster of Plaister underneath them to prevent their scratching: But when the lower Part only of the Hare Lip can be brought into Contact, it will not be proper to use more than one Pin.
The Pins I employ are made three fourths of their lengths of Silver, and the other Part towards the Point, of Steel; the Silver Pin is not quite so offensive to a Wound as a Brass or Steel one, but a Steel Point is necessary for their easier Penetration, which indeed makes them pass so readily, that there is no need of any Instrument to assist in pushing them thro'. The Practice of bolstering the Cheeks forward does little or no Service to the Wound, and is very uneasy to the Patient; wherefore I would not advise the Use of it. The Manner of dressing will be to remove the Applications which are quite superficial, as often only as is necessary for Cleanliness. The Method I would recommend, is to desist the three first Days, and afterwards to do it every Day, or every other Day: I do not think it at all requisite to dress between the jaw and Lip where the Frænulum was wounded, there being no Danger that an inconvenient Adhesion Should ensue. In about eight or nine Days, the Parts are usually united, and in Children much sooner, when you must gently cut the Threads, and draw out the Pins, applying upon the Orifices a Piece of Plaister and dry Lint. It will be proper, in order to withdraw the Pins more easily, to dab the Ligatures and Pins with warm Water, and also moisten them with sweet Oil, two or three Days before you remove them, which will wash off the coagulated Blood, that would otherwise fasten them so hard to the Ligature as to make the Extraction painful.
The twisted Suture is of great Service in Fistulas of the Urethra remaining after the Operation for the Stone, in which case the callous Edges may be cut off, and the Lips of the Wound be held together by this Method.