1911 Encyclopædia Britannica/Cleft Palate

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CLEFT PALATE and HARE-LIP, in surgery. Cleft Palate is a congenital cleavage, or incomplete development in the roof of the mouth, and is frequently associated with hare-lip. The infant is prevented from sucking, and an operation is necessary. Cleft-palate is often a hereditary defect. The most favourable time for operating is between the age of two weeks and three months, and if the cleft is closed at this early date, not only are the nutrition and general development of the child greatly improved, but the voice is probably saved from much of the unpleasant tone which is usually associated with a defective roof to the mouth and is apt to persist even if a cleft has been successfully operated on later in childhood. The greatest advance which has been made in the operative treatment of cleft palate is due to the teaching of Dr Truman W. Brophy, who adopted the ingenious plan of thrusting together to the middle line of the mouth the halves of the palate which nature had unfortunately left apart. But, as noted above, this operation must, to give the best results, be undertaken in the earliest months of infancy. After the cleft in the palate has been effectually dealt with, the hare-lip can be repaired with ease and success.

Hare-lip.—In the hare the splitting of the lip is in the middle line, but in the human subject it is on one side, or on both sides of the middle line. This is accounted for on developmental grounds: a cleft in the exact middle line is of extremely rare occurrence. Hare-lip is often associated with cleft palate. Though we are at present unable to explain why development should so frequently miss the mark in connexion with the formation of the lip and palate, it is unlikely that maternal impressions have anything to do with it. As a rule, the supposed “fright” comes long after the lips are developed. They are completely formed by the ninth week. Heredity has a powerful influence in many cases. The best time for operating on a hare-lip depends upon various circumstances. Thus, if it is associated with cleft palate, the palatine cleft has first to be closed, in which case the child will probably be several months old before the lip is operated on. If the infant is in so poor a state of nutrition that it appears unsuitable for surgical treatment, the operation must be postponed until his condition is sufficiently improved. But, assuming that the infant is in fair health, that he is taking his food well and thriving on it, that he is not troubled by vomiting or diarrhoea, and that the hare-lip is not associated with a defective palate, the sooner it is operated on the better. It may be successfully done even within a few hours of birth. When a hare-lip is unassociated with cleft palate, the infant may possibly be enabled to take the breast within a short time of the gap being closed. In such a case the operation may be advisably undertaken within the first few days of birth. The case being suitable, the operation may be conveniently undertaken at any time after the tenth day.  (E. O.*)