Fig. 62.—Angular long-handled catch forceps (the teeth are a little coarser than in the original).
Fig. 63.—Various forms of needles employed in palate operations. The left-hand figures show the double-curved needles used in suturing the uvula.
The needles best adapted for this work deserve a somewhat detailed description, inasmuch as the clumsy forms generally in use twenty years ago have been superseded by much more satisfactory and delicate instruments, which inflict less injury in passing through the palatal structures. Those most commonly employed are a special modification of the Hagedorn type of needle ([Fig. 63]), long, narrow, measuring with the handles about eight inches, fine, curved, and flattened laterally, with a small eye near the point, and so ground and set that there is only a short cutting edge on the convex side close to the extremity. The advantage of this is that when introduced quite close to the edge of the palate, its blunt concave border directed towards it has no tendency to cut its way out, whilst the convex cutting edge makes a track for the needle and suture to follow. It is manifest that the incision thus made is at right angles to the margin of the cleft, and consequently when the suture is drawn tight, the tendency is rather to close than to open the needle track. With the old needles making as they did in their passage an incision parallel with the edge of the cleft, the tightening of the suture caused the opening to gape, and this occasionally resulted in the establishment of a fistulous aperture leading to subsequent trouble. (Compare [Figs. 64 and 65].) Mr. T. Smith emphasised this point as far back as 1868. (Vide an interesting paper of his in ‘Med.-Chir. Trans.,’ vol. 51.)
Fig. 64.—Shows effect of drawing stitches together when needles cutting parallel to the edge of the cleft have been used, resulting in an oval opening at the site of each needle puncture.
Fig. 65.—Contrasts the effect produced when needles cutting at right angles to the cleft margin are used. There is no tendency to opening up of the needle tracks, but rather to close them.
With reference to the sutures, many different materials have been employed, such as silk, silkworm gut, catgut, horsehair, and fine silver wire. For many reasons the silver wire is to be preferred; it can be more easily and accurately adjusted to the required degree of tension, and has no tendency to slip; catgut and horsehair are often so springy that the knots are liable to come unfastened. Silver wire is less irritating, and therefore can be left for an almost indefinite period in situ; it is incapable of absorbing septic material, and is insoluble in the tissues. The method of introducing the wire stitches is described later ([p. 119]); the wire twister ([Fig. 66]) will be found useful for the purpose of regulating their tension.