Fig. 10.
Fig. 10.—Complete cleft palate without alveolar or labial deformity; the vomer is separate from the lateral segments. (Mason.)
Fig. 11.—Complete unilateral cleft palate without alveolar deficiency; the vomer is attached to the left palatal segment. (Mason.)
Figs. 12, 13, 14.—Various degrees of simple fissure of the palate. (Mason.)
Not unfrequently the vomer is attached to one of the margins of the cleft, this condition being usually associated with unilateral alveolar harelip. Such attachment always occurs on the side opposite to the fissure in the alveolus; that is to say, since unilateral harelip is more common on the left, the vomer is usually attached to the right side of the cleft. [Fig. 11] indicates the less common condition of attachment of the vomer to the left palatal segment. Rouge[2] and Oakley Coles[3] fully confirm this statement. The cleft may, however, merely implicate the soft and hard palate, leaving the alveolus and lip perfect, and does not then extend further forward than the site of the anterior palatine canal, and is strictly median ([Fig. 12]); or it may be still more limited, involving more or less of the velum, perhaps only the uvula, or extending a variable distance into the hard palate ([Figs. 13 and 14]).
Fig. 15.—Unusual form of cleft involving the alveolar arch, and the anterior portion of the palate only. (Mason.)
Other less common congenital deformities have been recorded, and amongst them may be noted a case lately seen by myself in a girl of four years, in whom there existed an oval opening at the junction of the hard and soft palate, separated by a narrow bridge of normal palatal tissue from a cleft of the posterior half of the velum and uvula, showing intermissions of development; a congenital aperture in the soft palate at its junction with the hard, or in any part of the velum, but with no defect of either uvula or palate bones (Dieffenbach[4]); a defective development of the palate bones alone, the mucous membrane remaining intact from side to side, and hence no cleft resulting (Trélat, Notta, Langenbeck); or again, as in [Fig. 15], a cleft only of the anterior portion of the palate, extending through the alveolus, and for a short distance behind it (Mason[5]). Inasmuch as the union of the two halves of the velum occurs subsequently to that of the alveolar arch, it appears that this last rare defect must have been due to an intermission of development, which was felt only at the anterior portion, whilst that of the posterior part proceeded normally at a later date.
Mason[6] records a curious case worth mentioning of a girl under his care in 1877, who had a fissure extending through the velum, and for a short distance into the hard palate, but there was no trace of uvula on either side, and the soft palate was continuous on both sides with the pharyngeal wall.