Fig. 153.—Bilateral Facial Cleft. (von Guersant.)
4. Buccal Cleft.—In the fourth variety the deformity involves the cheeks, the fissures extending from the angles of the mouth outward, causing an enlargement of this natural opening, and hence this defect is better known as macrostoma.
It may affect one or both cheeks. The latter is elucidated in [Fig. 154].
Fig. 154.—Buccal Fissure with Macrostoma.
On the other hand there may exist a congenital contraction of the mouth termed microstoma. This defect is rarely seen, and is due to a too free union of the maxillary and mandibular processes. When observed it is usually associated with improper development of the inferior maxillary bones.
5. Mandibular Cleft.—In the fifth class the cleft is to be found in the median line of the lower lip. This fissure, though extremely rare, may involve only the soft tissue or extend to the inferior maxillary (Thorndike) and even to the tongue (Wölfler).
From what has been said of the five varieties just mentioned it can be plainly seen that the defects of the second class are the most common. Since the correction of such involves methods of an extensive technique that can be followed more or less in the restoration of any of the above, this particular subdivision will be considered fully, but only to the extent of defects of the soft parts, leaving the osteoplastic and periosteoplastic operations to be studied elsewhere.
The defects that have to do with facial and buccal clefts will be more specifically mentioned later on under Melo- and Stomatoplasty.