Morgan reports two cases of congenital macrostoma accompanied by malformation of the auricles and by auricular appendages. Van Duyse mentions congenital macrostoma with preauricular tumors and a dermoid of the eye. Macrostoma is sometimes produced by lateral fissures. In other cases this malformation is unilateral and the fissure ascends, in which instance the fissure may be accompanied by a fistula of the duct of Stensen. Sometimes there is associated with these anomalies curious terminations of the salivary ducts, either through the cheek by means of a fistula or on the anterior part of the neck.
Microstoma.—There are a few cases on record in which the mouth has been so small or ill-defined as not to admit of alimentation. Molliere knew an individual of forty whose mouth was the exact size of a ten-centime piece.
Buchnerus records a case of congenital atresia of the mouth. Cayley, Smith, Sourrouille, and Stankiewiez of Warsaw discuss atresia of the mouth. Cancrum oris, scarlet fever, burns, scurvy, etc., are occasional causes that have been mentioned, the atresia in these instances taking place at any time of life.
Anomalies of the Lips.—The aboriginal tribes are particularly noted for their large and thick lips, some of which people consider enormous lips signs of adornment. Elephantiasis or other pathologic hypertrophy of the labial tissues can produce revolting deformity, such as is seen in Figure 100, representing an individual who was exhibited several years ago in Philadelphia. We have in English the expression, "pulling a long lip." Its origin is said to date back to a semimythical hero of King Arthur's time, who, "when sad at heart and melancholic," would let one of his lips drop below his waist, while he turned the other up like a cap on his head.
Blot records a case of monstrous congenital hypertrophy of the superior lip in an infant of eight months. Buck successfully treated by surgical operations a case of congenital hypertrophy of the under lip, and Detmold mentions a similar result in a young lady with hypertrophy of the lip and lower part of the nose. Murray reports an undescribed malformation of the lower lip occurring in one family.
Hare-lip may be unilateral or double, and may or may not include the palatine arch. In the worst cases it extends in fissures on both sides to the orbit. In other cases the minimum degree of this deformity is seen.
Congenital absence of the tongue does not necessarily make speech, taste, or deglutition impossible. Jussieu cites the case of a girl who was born without a tongue but who spoke very distinctly. Berdot describes a case in which the tongue was deficient, without apparent disturbance of any of the functions. Riolan mentions speech after loss of the tongue from small-pox.
Boddington gives an account of Margaret Cutting, who spoke readily and intelligibly, although she had lost her tongue. Saulquin has an observation of a girl without a tongue who spoke, sang, and swallowed normally. Aurran, Bartholinus, Louis, Parsons, Tulpius, and others mention speech without the presence of a tongue.
Philib reports a case in which mutism, almost simulating that of one congenitally deaf, was due to congenital adhesions of the tongue to the floor of the buccal cavity. Speech was established after removal of the abnormal adhesion. Routier speaks of ankylosis of the tongue of seventeen years' duration.
Jurist records such abnormal mobility of the tongue that the patient was able to project the tongue into the nasopharynx. Wherry and Winslow record similar instances.