«J- \ o. / Ao 2. THE 
MEDICAL EXAMINER, 
AND 
RECORD OF MEDICAL SCIENCE. 
NEW SERIES.—NO. LXI.—JANUARY, 1850. 
ORIGINAL COMMUNICATIONS. 
A Case of the Cheiloplastic Operation, with two portraits. By 
Abraham Stout, M. D., of Easton, Pennsylvania. 
In the month of November, 1844, David Steward, of Kingston 
township, Luzerne county, State of Pennsylvania, consulted 
me on account of an extensive disease of his lips. The report 
which he gave of himself was, that he was then fifty-three years of 
age, and a farmer by occupation ; had always enjoyed good health, 
and lived a very regular and temperate life. In 1839 the disease 
began with a chap in the middle of the lower lip, from which an 
excrescence grew and enlarged gradually to the attainment of the 
present size; it involved the whole of the lower lip, extended 
around both the angles of the mouth, and occupied about one half 
of the upper lip. 
The disease consisted of a tumour of a scirrho-cancerous nature, 
irregular on its surface, and extending nearly to the base of the 
inferior maxillary bone on the right side. [See the portrait No. 1, 
which gives a correct representation of the disease.] A yellowish 
sanies was constantly oozing from the whole surface of the tumour, 
which was about four times the thickness of a healthy lip ; 
VOL. xiii. 14 
Original Communications. 
[Jan. 
it was hard and not painful. It extended in the mouth to the 
gums, and loosened the two middle incisor teeth. 
At the first examination of the disease, I pronounced it incurable. 
This greatly depressed the spirits of the patient, who re- 
marked, that he had come a great distance with a determination to 
have this horrible disease removed, and he did not like to return 
home without having something done for him, however great his 
suffering might be. This remark induced me to take his case into 
more serious consideration. I examined the glands in the neck 
and face carefully, and found no disease in either. I then 
told him that an operation might possibly succeed, and made him 
acquainted with the nature and extent of the one required to give 
him the least chance of being cured. He immediately consented. 
After his system had been duly prepared, I performed the opera- 
tion in the following manner, in the presence of Doctors Cooper, 
Henry, Innis, Abernethy, Lachenaur and Swift. The patient being 
seated on a chair, and his head supported by an assistant, a 
thin piece of shingle was introduced between the lip and the 
teeth. I commenced an incision in the sound part of the upper 
lip, and carried my scalpel in a circle around the tumor into the 
cheek, opposite the left angle of the mouth, on the left side of his 
face, then obliquely downwards and forwards to a point nearly at 
the base of the inferior maxillary bone. From this point an arched 
incision was made in front of the chin to a corresponding point on 
right side, and from here upwards and backwards into the right 
cheek opposite the angle of the mouth, and from here a circular 
incision above the disease into the sound portion of the upper lip. 
Ligatures were now put upon the bleeding arteries, and the dis- 
eased mass removed by cutting it close from the inferior maxillary 
bone. At this stage of the operation, the patient felt faint, and 
we were obliged to give him wine and a few minutes rest. After 
he had revived, I extracted the four inferior incisor teeth, and then 
removed the gums and alveolar processes by sawing on each side 
of the space which the teeth had occupied, and in extent a little 
below the termination of the sockets of the teeth. The projecting 
alveoli wrere next removed with a chisel and the bone nippers. 
This constituted the second stage of the operation, when the 
patient again required some wine and rest. As soon as he had 
regained his strength,! cut the soft parts from the anterior surface of 1850.] 
Stout’s Case of Cheiloplastic Operation. 
15 
the jaw bone, and on each side as far back as the centre of the space 
between the middle of the chin and the angles of the bone, and down 
about midway from the base of the chin to the upper part of the 
pomum adami, continuing in progress anterior to the platysma 
myoides muscle. The flap was then drawn forwards and upwards, 
and the edge brought into contact with the edge of the remaining 
upper lip, and secured on each side by several twisted sutures, leav- 
ing space enough for a mouth. A compress of lint was laid over 
the chin, and supported by adhesive straps so as to keep the flap 
in close contact with the parts under it, in order to promote their 
union. Here terminated the third and last stage of the operation. 
A large dose of wine was now given to the patient, and he was 
put to bed. He soon recovered from the shock of the operation, 
and afterwards did remarkably well. He was nourished by giving 
him drink and Indian gruel frequently from the spout of a tea-pot. 
On the fourth day after the operation, the twisted sutures were re- 
moved, when the parts had completely united by the first inten- 
tion. On the tenth day after the operation, the portrait No. 2 
was taken by Mr. Samuel Moore, a very talented artist, and it is a 
faithful representation of the patient’s face as it was then. His 
mouth was rather too small at first; but the lips have gradually 
stretched so much, that it is now, for all purposes, large enough. 
About a year after he had returned home, he accidentally bit his 
lower lip, from which cause it inflamed and became very sore ; but 
the inflammation soon subsided, and the sore healed without any 
difficulty, and has continued well up to the present period, April 
24th, 1848. 
Remarks.—The soreness and inflammation in David Steward’s 
lip, in consequence of his biting it, may be looked upon as a test 
establishing the important fact, that the disease for which he has 
been operated upon, is not likely to return. Had any predisposi- 
tion of a return of the disease existed, it would, in all probability, 
have been called into action by the soreness and inflammation. 
Before I had separated the flap for the formation of the artificial 
lip from its connection to the inferior maxilla, I apprehended the 
necessity of making a transverse cut into the flap under the jaw 
bone, to enable me to bring the edge, or artificial lip, in contact 
with the upper lip; but I was surprised at the great ease with 
which it was brought up without such a cut. I could not only 16 
Original Communications. 
[Jan. 
readily bring it into contact with the upper lip, but with the nose 
also; and I wrould not be surprised, if, in the future, surgeons 
would form both upper and lower lips, and consequently a complete 
artificial mouth, from the integuments of the chin. 
The case of David Steward strongly admonishes us not to come 
to a conclusion too hastily, and turn our patients off by pronounc- 
ing their cases incurable. Had he not insisted upon it that he 
would have something done for the removal of his disease before 
he would return home, he might perhaps to this day be laboring 
under that disgusting disease, and I might still consider his case 
incurable. I think now, that a surgeon ought to advance as far 
as any other surgeon has ever gone, and them venture a step 
further, for the comfort and prolongation of the life of his patient.