THIS common deformity is due to non union of the middle nasal cartilage with the upper jaw bone. There may be (a) a mere notch in the red edge of the lip; (b) a cleft through the soft portion of the upper lip only; (c) a cleft through the lip and nostril and accompanied by cleft palate; (d) double hare lip with a floating piece of bone and a cleft palate, a variety witnessed in one tenth of all cases. In the latter case the pieces of bone usually project and are either covered by skin or connected with the nasal septum, projecting sometimes as far as the tip of the nose.
When the cleft extends into the nose there is always a simultaneous defect involving separation of the middle and lateral incisor teeth.
Other deformities of the face, due to defect in development, are sometimes present: fissure of the cheek, eyelid, etc. Single hare lip occurs most frequently on the left side. It is often traceable to heredity.
Treatment. Operative procedures are alone of value, the age at which these should be resorted to giving rise to considerable discussion. The resisting powers of the child should first be determined; while one may easily stand the operation a few weeks after birth, another will die from shock.
The best age for operation for harelip depends on the condition of the child and the character of the deformity. Should only the soft parts be involved operation should be done at once. In simpler cases the earlier the operation the better.
Should the child be weakly, or the fissure be double and extend through the hard parts, then the operation ought to be postponed some weeks or even months. From six weeks to three months is probably the proper time for operating. Before operating it is very important to know that the child has not been exposed to any contagious fevers, like measles, or scarlatina. This is one cause of failure. Another is the continued crying of the child, and also the too early removal of the stitches; sutures should not be removed too soon, being left in from six to ten days. Sepsis is the greatest cause of failure.
After the operation, if there is difficulty in breathing through the nostrils, rubber tubes introduced will be found a great aid and prevent collapse of the nostrils. The parts should be kept clean with aseptic washes before the operation.
Harelip babies are not necessarily feeble at birth, and by proper feeding can be kept up to the normal standard.
The opposite diagram shows the exact mechanism of a sneeze. When pollen or any other irritating body enters the nostrils it lodges in the Schneiclerian membrane and irritates the nasal nerve, A, the sensation follows the fifth nerve, B, to Meckel's ganglion, C, whence it reaches the sympathetic nerve system, D. It passes along D and is carried by the phrenic nerve F,, controlling the diaphragm. Under the irritant nerve impulse there is a spasm of the diaphragm which forces a violent expiration of air from the lungs G, up through the trachea, H, out of the mouth and nose I, producing what we call the sneeze.
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