THE AUTHOR'S OPINION OF OBTURATORS.

247

had always observed the marked improvement in voice that a metallic sounding-board gave over one of either hard or soft rubber. In the present instance the gentleman, after wearing it a day or two until feeling quite familiar with it, called to his aid a professor of elocution and went into a large public hall, and for an hour subjected himself to criticism in reading, in singing, and in declamation. The professor pronounced his effort as absolutely without fault, and the clearness, distinctness, and resonance of his voice remarkable.

The sum of my experience with obturators is this:

1. That of all obturators this is the best form for a congenital fissure; but, while the wearer is enabled to articulate perfectly with such an instrument, it is only after he has learned articulation with another apparatus.

2. That a soft, elastic artificial velum is much better adapted to the acquirement of articulation than an unyielding, non-elastic substance; but when acquired an obturator may be substituted.

3. That in very rare cases articulation may be acquired with an obturator only; but it is the result of the extra activity of the pharyngeal muscles, while with the elastic velum the levators of the palate contribute largely.

CHAPTER X.

TREATMENT OF ACQUIRED LESIONS OF THE PALATE.

ANY unnatural opening from the oral to the nasal cavity which will permit the free passage of the breath will impair articulation. Any appliance which will close such passage, and can be worn without inconvenience, will restore articulation.*

Obturators were formerly made of metallic plate, gold or silver being most commonly employed, and many ingenious pieces of mechanism were the result of such efforts; but latterly vulcanized rubber and celluloid have almost entirely superseded the use of metals. These substances have been found preferable to metals, being much lighter and more easily formed and adapted, particularly when of peculiar shape.

From the preceding history of obturators we see that the makers have in most instances sustained the apparatus by passing into or through the opening, and by pressure upon the surrounding tissues. As early as 1756 Bourdet recognized the impropriety of such a procedure, for he says: "Before considering the cicatrized perforations of the palate as being of a nature incapable of diminishing in diameter, practitioners should satisfy themselves thoroughly and beyond a doubt that such is the case. We do not think that this con

*The student will bear in mind that no cognizance is here taken of openings similar to those described in cases of congenital fissure, where the surgeon has united the soft palate, and left an opening through the hard palate to be covered by an obturator.

EXTENSIVE ABSORPTION, THE RESULT OF PRESSURE. 249

dition of permanency can exist, for positive facts attest the contrary; and as holes made in the cranium with the trepan close almost entirely, in like manner those of the palate constantly diminish."

Numerous examples might be adduced to prove the impropriety of sustaining an obturator by any fixtures which act upon the lateral parts, as they necessarily tend to increase the dimensions of the opening in the palate. In a case re

cently in the author's practice, the patient closed a small perforation of the hard palate with a wad of cotton, the swelling of which tended to enlarge the opening and necessitated a still larger plug, until the entire roof of the mouth and teeth were carried away, leaving but a narrow rim along the alveolar border. Such a case is shown in Fig. 170. Cases have also occurred in the author's practice where palatine openings, resulting from disease, have been carefully bridged over with a plate without entering the perforation or cavity; healthy granulations were stimulated, and the opening even

250

TREATMENT OF SIMPLE PERFORATIONS.

tually closed, thus doing away with the necessity of an obtu

rator.

It is of the greatest importance that all such instruments should be executed in the most perfect manner, and made to fit accurately all the parts with which they are to be in contact, so that they may not produce the slightest irritation or exert undue pressure upon any of the surrounding parts. This is even more essential than in fitting an artificial denture in a healthy mouth, as in the latter case the tissues recover their tone often in spite of the irritation of a badly fitting denture; but, in palatal lesions resulting from disease,

the system is generally in such condition that a slight irritation may be followed by alarming inflammatory symptoms.

In simple perforations of the palate, a plain plate of vulcanite, celluloid, or metal, covering the gap and fitting close to the adjacent palatal surface, without any attempt to enter the opening, and sustained by the natural teeth, is all that is required. Fig. 171 represents such an obturator, sustained in its place by impinging upon the natural teeth with which it came in contact. Accuracy of adaptation and delicacy of form are all that are essential in such cases, and restoration of the speech will immediately follow.

Fig. 172 represents a more complicated obturator, adapted to an opening in the soft palate. The necessity for a variation in the plan will be found in the constant muscular action

IMPRESSIONS OF PALATAL PERFORATIONS.

251

of the soft palate, which would not permit without irritation the presence of an immovable fixture. This is contrived, therefore, with a joint, which will permit the part attached to the teeth to remain stationary, while the obturator proper is carried up or down as moved by the muscles. The joint, A, should occupy the position of the junction of the hard and soft palates. The joint and principal part of the appliance is made of gold, the obturator of vulcanite. The projection B lies like a flange upon the superior surface of the natural palate and sustains it; otherwise the mobility of the joint would allow it to drop out of the opening. This flange is better seen in the side-view marked C. It is readily placed in position by entering the obturator first, and carrying the clasps to the teeth subsequently.

Figs. 171 and 172 will illustrate the essential principles involved in all simple obturators. The ingenuity of the dentist will often be taxed in their application, as the cases requiring such appliances all vary in form and magnitude.

The steps to be taken in the formation of an obturator are not unlike those used in making a base for artificial teeth. It is essential that an accurate model be obtained of the opening, the adjacent palatal surface, and the teeth, if any remain in the jaw. For this purpose, an impression taken in plaster is the only kind to be relied upon. Care must be used that a surplus of plaster is not forced through the opening, thus preventing the withdrawal of the impression by an accumulated and hardened mass, larger than the opening through which it passed. To avoid this, beginners or timid operators had better take an impression in the usual manner with wax. If this is forced through, it can be easily removed without injury to the patient. From this wax impression make a plaster model, and upon this plaster model form an impression-cup of sheet gutta-percha, using a stick, piece of wire, strip of metal, or any other convenient thing for a handle. This extemporized impression-cup must not impinge upon the borders of the opening, neither should it enter to