TUMORS OF THE FACE Aside from the more frequent congenital facial deformities referred to, such as harelip and palatal cleft, other more or less rare defects may occur in the facial skull owing to non-union of primordial lobes. By the non-union of the upper maxillary process with the lateral nasal process a rare fissure occurs which is designated as— Oblique Facial to Morian it commences as a lateral harelip, extends into the nares and further up toward the eye, produces a cleft in the lower eyelid (coloboma) and often continues obliquely beyond the upper lid toward the forehead. Thefe is another form which likewise begins as harelip, but runs laterally alongside the nose to the eye. A third rare form begins at the angle of the mouth and extends to the region of the infraorbital canal (Fig. IS).
The lightest forms, consisting of harelip and coloboma at the inner canthus, should be treated on the surgical principles we have discussed. More extensive defects demand more complicated plastic procedures, which will vary with the requirements of each case. The relief of defects of the mucous membranes presents great difficulties in these cases.
Transverse facial cleft is a gap between the upper maxillary process and the lower maxillary arch. The mouth is enlarged toward the ear, and frequently a raphe extending to the ear indicates the retarded incomplete union (Chavanne, Ashby and Wright, Forgue). (Sec Fig. ls.) The development of the lower lip presents the very rare occurrence of median fissures. The same kind of fissures may occur at the upper lip and the nose, which, aecording to Lannelongue, may be explained by a notch of the median frontal process or, better perhaps, by its total absence. Landow, Broca, Kredel, and others observed rt lateral nasal fissure which appears as a defect of the a]a nasi or runs right through one of the nasal cavities; in the latter case it resembles an oblique facial cleft.
This ramification of deformities allows considerable opportunity for the formation of fistukc (incomplete closure) as well as for excess formations of all kinds, among which deep displacements of ectoderm nuclei may be described.
Facial fistulT may, for instance, be found at places where there are fissures of the upper and lower lips.
More frequently fistulw occur in the region of the external ear. They are often bilateral and symmetrical, and owe their origin to the non-union of the various parts of the palatal arch which participate in the strueture of the ear.
The fistular duets may assume a cystic character by partial or total occlusion of the lumen and by accumulation of the secretions of the mucous glands of the cystic wall.
It is at these very places that fibrochondromala very frequently occur (Fig. 10), which may he observed as small, pendulous, skin-co ered appendices at the sides of the helix or in the neighborhood of the palpebral fissure. They are generally covered with skin and contain adipose tissue and a cartilaginous nucleus (descendants or the middle blast oderm).
Teratoma and dermoid cysts in the region of the face and skull arc excess formations From scattered nuclei of the ectoderm which have un dergone independent development (Kaufmann). They are mostly found in the vicinity of the osseous sutures and primordial Essures. Pathologico-anatomically they are characterized as small, grow ing subcutaneous tumors, above Nvhich the skin is normally mov able. They consist of a coarse sac containing, aside from tallow and epithelia (detritus), all those struc tures which the ectoderm is capable of producing (hair, teeth).
Histologically this sac is of the same structure as the outer skin (see Tumors, Sebaceous cysts). In the region of the head they are most Frequently found at the gla bella, in the vicinity of the sutures, at the orbital margin, near the ears, and in the buccal cavity.
The only possible treatment of all these formations, listulte, cysts and tumors, is their operative removal, which can easily be accomplished on ordinary surgical principles.