Operation for Single Harelip.
For convenience of description, the operation may be divided into three stages:
1. Detachment of the lip from the maxillæ.
2. Preparation of the edges of the cleft.
3. Union by sutures, and application of dressing.
Stage I.—Detachment of the Lip from the Maxillæ.
The importance of thoroughly loosening the attachment of the lip to the maxillæ and alveoli cannot be too strongly insisted on; and although emphasized in monographs on the subject by several authors, yet in our ordinary surgical text-books it is but scantily noticed or not alluded to at all. Unless this proceeding is carried out efficiently, the tension upon the stitches subsequently inserted will be so great as to hazard successful union, and will prevent the surgeon from obtaining a symmetrical adaptation of the parts. In severe cases it may be necessary to carry the knife as far as the infra-orbital foramen, and I have often had occasion to go close up to the orbital margin to gain as much freedom as was needful. The maxillary attachment of the ala nasi must also be completely divided, so that the flattened and distorted nostril may be made to correspond in shape and form to that on the opposite side. This dissection in single harelip is mainly needed to the outer side of the cleft, but rarely to such an extent as described above unless the cleft be very wide.
The knife must be kept close to the bone in order to minimise bleeding, and not unnecessarily to lacerate muscular and other structures. Sponge pressure will readily control any hæmorrhage. Afterwards the plastic exudation that results is useful in steadying the mask of the face, and the temporary division of facial muscles has a like effect.