Plastic and cosmetic surgery

by Frederick Strange Kolle

The Operative Correction of Harelip

The correction of a harelip should be undertaken as early as the first two weeks after birth in the healthy child. If, however, the infant is considered too delicate to undergo so early an ordeal, the operation should be deferred until the third or even the fifth month. At any rate the operation should be undertaken as early as deemed advisable, since the closure of the cleft has a desirable effect upon the ofttime overprominent intermaxillary bone, helps to approximate its lateral borders, overcomes the later depression deformity of the upper lip, aids its natural development, and permits of the child suckling the breast—an important factor in the proper nourishment, since the defect allows only of feeding with the spoon, the child being unable to grasp the nipple of the breast in this state. Furthermore, the act of phonation is practically entirely perfected by an early operation, and rarely if ever overcome when faulty phonation has been established.

Unilateral Labial Cleft

The restoration of an unilateral cleft is to be performed without the use of an anesthetic. The child’s arms are fastened to its sides with several turns of a wide roller bandage. It is then seated upon the lap of the assistant, who holds its head in position, compressing the coronary arteries with his fingers at the outer sections of the upper lip at the same time. If this is impractical, proper forceps can be employed, as already mentioned. It is rarely necessary to employ the direct-ligature method heretofore referred to in this class of operations. More or less bleeding always accompanies the operation, the child usually swallowing what enters the mouth if not sponged up repeatedly.

To facilitate matters the child can be anesthetized, chloroform being used. In this case the patient is to be placed on its side, the head being fixed in a dependent position (Rose).

This gives freer drainage of the bleeding surfaces, the blood being sponged up with gauze sponges as required, while the vessels that are cut can be tied off with catgut ligatures as fast as they are divided.

The anesthetic can be given upon a small sponge held before the nostrils. Infants should not be anesthetized, yet in older children it is almost always necessary.

A simple freshening of the edges of the defect with the bistoury, followed by suture, does not give a desired cosmetic effect, hence it is advisable to resort to methods intended to restore the lip as far as possible to its normal state.

Nélaton Method.—The simplest operation for a cleft of moderate extent not involving the nare is that of Nélaton. He divides the lip above the angle parallel with the defect with a bistoury, cutting upward, including the upper angle which allows the prolabium surmounted by a thin strip of skin to droop downward in a point.

The lower angle of the wound is then drawn downward and united lengthwise with silkworm gut sutures, giving to the prolabium a protrusion or tip, which eventually retracts and causing the lip to assume a natural aspect.