Fig. 58.—Mason’s gag.
Fig. 59.—Rose’s gag, double ended. Large end for adults; small end for children. Sliding ring-catch fixing instrument in position.
An efficient gag is one of the most important requisites for a rapid and successful performance of this operation. In the selection of such appliances the choice will lie between those which merely separate the jaws and those which, in addition, command the tongue. The latter are represented by such as T. Smith’s ([Fig. 57]) or Whitehead’s gags; but with either the tongue is apt to curl up at the back of the plate which is intended to repress it, and severely embarrass, if not altogether interfere with respiration, necessitating a hurried readjustment. Any gag with a tongue plate is not only more difficult to adjust, but also to remove in an emergency. I am inclined on the whole to think that it is better to leave the tongue free, the assistant depressing it, when necessary, with an ordinary spatula. The apparatus should be as simple as possible, unilateral, and easily moved from one side of the mouth to the other, and constructed with a minimum amount of metal and projections which might obscure the field of operation, or cause delay by entanglement of the stitches. These conditions are, I believe, fulfilled as nearly as possible in my own adaptation of the late Mr. Francis Mason’s gag, generally used by Sir Wm. Fergusson ([Figs. 58 and 59]). As will be seen from the drawing, the gag is unilateral, provided with a sliding ring-catch easily thrown in and out of position, and so made that by reversing ends it can be used either for an adult or a child. The portions inserted between the teeth are covered with rubber tubing or fine twine, thus protecting them from injury, and in some measure preventing the gag from slipping. I admit that the supervision of an assistant is needed to maintain its position, but contend that this is rather an advantage than otherwise, and the breathing is less likely to be interfered with. It is inserted closed between the lateral incisors, and is gently pushed back until between the molar teeth, when it is opened to a sufficient extent, and fixed in that position by the sliding catch.
Fig. 60.—Various forms of raspatories employed in detaching the muco-periosteal flaps in uranoplasty. The three in the left-hand lower corner are used for detaching the flaps anteriorly (After Durham).
Fig. 61 A, B, C.—Fine hook forceps. Long smooth-nosed forceps. Knife for paring the edges of the cleft (Mason).
A small scalpel, raspatories of various shapes, right and left-handed ([Fig. 60]), long smooth-nosed, and fine hooked forceps, and a long-handled, narrow-bladed, very sharp paring-knife ([Fig. 61]) are necessary. For seizing the edge of the cleft in order to remove the mucous membrane therefrom, the surgeon will find the forceps depicted in [Fig. 62] extremely useful; they are an adaptation of a pair of German trachelorraphy forceps, and possess the following advantages: first, by their angular prehension they can seize the exact edge of the palate, and then when seized, the hold is maintained by means of a spring catch in the handle. It is obvious that a pair of straight hooked forceps ([Fig. 61 A]) introduced into the mouth cannot so certainly seize the edge, whilst the slightest relaxation of the fingers causes it to loose its hold.