2. By clamping off the site of operation with specially made cutisector forceps. Its smooth parallel jaws should be curved outward, so that the diseased area can be fully excluded by their concavities.
3. By employing the indirect ligature of Langenbuch. This is accomplished by including the site of operation with several strong silk threads firmly tied in loops upon the skin surface, each loop including a given amount of tissue, the next encroaching upon it up to the center of this area, and so on until the entire site is rendered anemic. The advantage of this method is that with the anemia a certain amount of anesthesia is produced at the same time; a fact to be remembered when the patient is to be operated under local anesthesia, the anemia enhancing the efficacy of the latter.
HARELIP
A congenital defect of the upper lip caused by the lack of proper union of the maxillary, globular, and frontonasal processes in embryo. Treves states that from the buccal aspect of the maxillary process of either side the palatal processes arise, passing inward to combine with each other to form the soft palate and all of the hard palate, except the intermaxillary portion, and that from this same source are formed the cheeks, the outer or lateral parts of the upper lip, and the superior maxillary bones, while the external nose, the ethmoid, the vomer, the median portion of the upper lip, and the intermaxillary or os incisivum are derived from the frontonasal process.
The fact that these centers of development are concerned in the formation of the parts involving harelip accounts for the position of the cleft in the lip as being unilateral or bilateral, and rarely if ever median or intermaxillary.
Classification of Harelip Deformities
Six varieties of harelip deformity are recognized by Rose, but herein only five classes of these will be considered, one of which, the first, is so rare that its occurrence is practically denied.
For all purposes in surgery of the face, in which cosmetic effects are sought, the author considers the following classification to answer fully:
- 1. Median or intermaxillary cleft.
- 2. Single and double cleft.
- 3. Facial cleft.
- 4. Buccal cleft.
- 5. Mandibular cleft.