Harelip is a congenital deformity of the upper lip, characterised by a
cleft extending for a variable depth, either through the soft tissues of
the lip only, or implicating in addition the alveolus, floor of the nose,
and palate. No mention of this condition is made by Hippocrates, Galen,
or any of the fathers of medicine; and so far as I can discover the name
is first used by Ambrose Paré, who probably initiated the treatment by
pin and figure-of-8 suture. The name is really a misnomer, in that the
condition (as has been many times pointed out, but notably by Fergusson)
does not simulate a hare’s lip except in the fact of being cleft, for
the natural cleft in the animal’s lip is always in the median line
below, bifurcating above to reach either nostril (Fig. 1), whereas in the
abnormal human lip the cleft lies to one or the other side. Instances of
median defect are known, but they are extremely uncommon, and consist
often of more than a simple fissure.
[Illustration: FIG. 2. FIG. 3. FIG. 4.
FIG. 5. FIG. 6.]
The deformity may exist as a simple notch in the soft tissues of the
lip, unilateral (Figs. 2 and 3) or bilateral (Fig. 4); when more
decided, it may implicate one or both nostrils (Figs. 5, 6, and 7). In
mild cases the alveolus is intact; in others, cleft, constituting the
variety known as _alveolar harelip_, and the line of fissure may, or may
not, extend backwards into the palate. In all cases of double alveolar
cleft, the palate is also involved, and the central parts of the lip
and intermaxilla tend to project forwards; in the severest forms these
portions are completely isolated from the maxillæ, and, supported by the
vomer and septum nasi, form a proboscis-like appendage to the end of the
nose, which is excessively disfiguring. (Figs. 7 and 8 illustrate this
deformity as seen from the front and in profile.)
The shape of the nose in unilateral harelip is very characteristic,
being broad and flattened out from the deficiency of the floor and
posterior wall of the anterior nares.
[Illustration: FIGS. 7 AND 8.—Double harelip with projection of the os
incisivum, as seen from the front and in profile. (_Fergusson._)]
Harelip seems to occur more commonly in boys than in girls. According to
Müller, out of 270 cases, 170 were boys, and 100 girls.
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