Association with other Deformities.
Occasionally, besides the fissured palate or lip, other deformities are noted in the same patient, but not so often as one might be led to expect. Mason records two or three cases as having come under his notice, the coincident deformities being respectively fistulous openings of buccal glands in an everted lower lip, congenital fissure of the lobe of the right ear, congenital talipes calcaneus and hypospadias. Dr. F. Warner records in the ‘Medical Times and Gazette,’ January, 1882, some cases of cleft palate associated with congenital defects of the heart and smallness of head, and also notes in his more recent report[7] that in 117 cases of malformations of the palate, other than cleft, only 42 were not in combination with other defects. Thus in 55 cases there were abnormalities in the shape of the cranium, in 16 cases defective development of the ear, in 12 the existence of an epicanthic fold, and in 15 cases other defects not tabulated.
Clutton[8] records and pictures a curious development of a flap of mucous membrane on the lower lip of a woman with a cleft palate; it was triangular in shape, and with overhanging projecting angles. The teeth in this case were likewise badly developed, and were all extracted at the age of nineteen.
Binet[9] reports a case of an old cured right-sided harelip in a man dead from apoplexy (æt. 53 years) with infantile genital organs.
Broca[10] describes a much deformed fœtus, stillborn at seven months, which he dissected, showing a double harelip and cleft palate, but the os incisivum retained its usual position, thanks to its mucous covering. The dentition,[11] as noticed elsewhere, was also interesting, and the buccal deformity was associated with a congenital diaphragmatic hernia, and an abnormal condition of the heart and great vessels.
Other associated malformations are on record, e. g. an extra thumb on each hand; and Sir Morell Mackenzie has reported a case in which there was a congenital fissure between the arytænoid cartilages with a trilobate epiglottis, occurring in conjunction with harelip and cleft palate.[12]
The remaining deformities to be noticed here are much less common, but demand attention by their rarity and interest, and on account of the light they throw on the embryology of the lip and mouth.