Unilateral harelip is more commonly met with on the left side than on
the right; probably 60-70 per cent. of the cases are left-sided. Thus
Müller reports 142 left-sided against 62 right-sided clefts; Mason, out
of 65 cases, found 54 to be unilateral, and of these 35 left-sided to
19 on the right; Kölliker mentions that in 165 unilateral clefts, 113
were on the left side, and 62 on the right. My own experience quite
coincides with these figures. At present, no satisfactory explanation
of this preponderance of left-sided clefts has been given. One solution
suggests itself, but we have no facts of importance to support it, viz.
that, inasmuch as the majority of people are from heredity or education
right-handed, Nature devotes more energy to completing her developmental
processes on that side than on the left, and any check to this would
be more likely to happen on the left side. It would be valuable and
interesting to know in what proportions other unilateral deformities
occur on the left and right sides respectively.
Occasionally one sees in the upper lips of children a congenital red line
_apparently_ cicatricial, occupying the position of the normal harelip
fissure, and which has been supposed to indicate a natural cure of a
temporary defect of development. My colleague, Mr. Carless, has recently
shown me a case of this character under his care in a child a few weeks
old. There was a well-marked red line extending from the lip margin to
the nostril; but there was no irregularity in the red border, and no
evidence of cicatricial contraction; the tissue of the lip, moreover,
seemed quite soft and normal, not fibrous or hard. These points seem to
bear out fully Trendelenburg’s opinion[1] that the name “intra-uterine
cicatrisation or cure of a harelip” is incorrect, and that such cases
are simply due to the raphe of union remaining evident instead of
disappearing as usual; and he quotes the normal appearance of the raphes
in the scrotum and perinæum as similar conditions. In this child there
was no evidence of any groove or depression in the alveolus; but other
deformities were present, viz. a very definite post-anal dimple, the
cicatrix being adherent to the tip of the coccyx, a slight condition
of hypospadias, and a congenital hydrocele. There was no history of
deformity in the family, nor of maternal impression.
CLEFT PALATE.
This is a congenital deformity due to non-closure of the horizontal
palatine outgrowths extending inwards from the maxillary processes. The
name must not be applied to acquired fissures or defects of the palate
due to injury or to disease of the bones later in life. (See Chap. IX.)
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