It will be convenient to append here a description of some of the better known methods of operating on unilateral harelip, with a few words of criticism on each.
1. Graefe’s method is applicable only to incomplete clefts in the soft tissues. He prepares the edges by an arch-like incision ([Figs. 47 A and B]), and brings them together with the muco-cutaneous margin even. It will be seen that a notch must necessarily result (in spite of the successful appearance in the picture which I have borrowed) from cutting the red margin of the lip in this manner.
Fig. 47.—Graefe’s operation. The completed lip is an impossible diagram of the result of such a section.
2. Nélaton’s method ([Figs. 48 A and B]).—In this no tissue is removed, but the margin is freed by a semicircular incision skirting the cleft and extending through the whole thickness of the lip. The centre of the fissure is then drawn down, and the opening thus created is brought together laterally so as to cause the lower portion to protrude as a prolabium. It is only suitable for very mild cases of harelip where the nostril is not involved, and has been adopted in the secondary treatment of the 𝖵-shaped notches, the results of previous operations. It will be noted, however, that the prolabium in this case consists mainly of cutaneous tissue, and that there must necessarily be an unsightly break in the red margin of the lip, which makes it a most undesirable proceeding.
Fig. 48.—Nélaton’s operation. No tissue removed, but the loosened margin pulled down and sutured.
3. Malgaigne’s operation ([Figs. 49 A and B]) was suggested for unilateral harelip where the fissure does not extend into the nostril. No tissue is removed, but flaps are turned down from the apex of the cleft on either side, the incision stopping at the red margin of the lip. Knife or scissors may be used. The flaps are drawn down and united to form a prolabium, whilst the raw surfaces, necessarily left above, are united from side to side. The same objection applies to this as to Nélaton’s operation, viz. the break in the red margin of the lip caused by the interposition of integument.
