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Harelip and Cleft

palate, upper and lip

HARELIP AND CLEFT PALATE.—The formation of the face in the developing child is accomplished by outgrowths which proceed from the forehead and the upper jaw on both sides, joining in the centre. The more or less incomplete union of these outgrowths, in consequence of dis turbances of development, results in permanent fissures in the upper lip, in the upper jaw, or in the palate. These fissures may vary as to form and extension. A fissure of the upper lip forms the so-called harelip. This may consist either in a slight cleft at the border of the lip ; or the fissure may extend through the entire lip up into the nostril (see Figs. 208, 209, 21o). As a rule, the cleft is not formed in the centre of the lip, but slightly to one side. A harelip may exist alone, or it may be combined with a cleft of the upper jaw and palate (cleft palate). Sometimes a cleft may form on each side, leaving an intermediate space between.

Harelips not only disfigure the face, but are harmful to the health of the child. Nutrition usually suffers considerably, especially if also the palate is fissured so that the milk flows out through the nose. Intestinal catarrhs soon follow, and the deficient closure of the mouth often causes affections of the lungs. It is, therefore, not only desirable, but urgently

necessary, to remove the harelip ; and this should be attempted as early as possible. The treatment is operative, and in the mild cases usually easy to perform. The severe cases require great skill. The stronger and healthier the child, the more favourable are the prospects of a satisfactory cure ; the poorer its nutritive condition, the less hopeful the treatment. Unfortunately, the latter is often the case, as many parents «•i11 not agree to an operation until they see for themselves that the health of the child becomes more and more impaired.

Conditions are different in cases of cleft palate. In these affections the fissure may be either single or double, a projecting centrepiece separat ing the clefts if the latter condition exists.

The operative union of the separated parts of the bones is a more serious matter than suture of the lips, and the treatment is not well borne by all little children. The surgeon will be the proper judge as to the best time for performing the operation.