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Traumatic cleft lip
T R A U M A T I C CLEFT LIP
By OTTO .B. KRIENS, M.D., D.D.S.
Kieferklinik der Universitiit Erlangen-Nitrnberg, Glitckstr.zG 8520 Erlangen, Germany. CLEFT lips of non-congenital origin are rare. Trauma, for example from traffic accidents or dog bites, is the usual cause. An unrepaired traumatic cleft lip will only be observed in areas without surgical aid available or when cruelty or neglect of a child occurs as in the present case. A careful search of the literature did not reveal a similar deformity.
A
D
FIG. I
A. " Cleft lip " on admission. B. Post-operative result. C. Intra-oral view exposes extensive scars in the maxillary vestibule, deviation of the columella and malalignment of teeth. Note the protrtision of the right upper incisor into the area of the lip defect. D. Lip in whistling position shows cleft lip deformity of the right nasal entrance, base of columella, philtrum, and slight shortness of lip in the cleft area. There is a scar in the lower lip vermilion (see A). 69
7°
BRITISH
J O U R N A L OF P L A S T I C S U R G E R Y
Case R e p o r t . - - T h e boy 1 was referred from a public health physician to have a repair of his cleft lip which was believed to be congenital. The boy is the first of twins born into a ruined family life. He lived in different children's homes for the first three years of his life. Then he was returned to his divorced mother and stayed with her until he was 12 years of age when, being deserted by the mother, he had again to be taken to a children's home. At that time a cleft lip was recorded in the admission papers. When asked about the deformity of his
FIG. 2 Partial lip cleft with left upper medial incisor being protruded through the cleft.
upper lip, the boy believed it might have resulted from a fall downstairs as he had once been told. It was impossible to discover whether his wound healed by second intention because of neglect to obtain surgical treatment or whether his mother, possibly because of a criminal infliction of the wound, did not seek it. Clinical findings.--The vermilion and adjacent lip white were cleft in about a quarter of the vertical length of the upper lip. The medial portion of the vermilion was puUed up towards the end of the defect, whereas the lateral stump seemed to hang down. There was an atrophic white vertical scar, 9 mm. in length, lateral to the right philtrum edge (Fig. I, A). The impression of a congenital partial lip cleft was simulated by the columella and philtrum deviating to the unaffected side, especially during function (Fig. I, D). However, broad scars on the mucosal side of the lip and in the fornix of the oral vestibule along with the scar in the lower lip vermilion suggested a traumatic mtiology (Figs. I, c and D). The defect in the orbicularis otis muscle seemed to have contributed to the malposition of the first right upper'incisor (Fig. I, D). A similar protrusion of a maxiUary incisor can be observed occasionally in congenital cases who have not had their cleft lip repaired prior to the change of dentitions (Fig. 2). Treatment was similar to that in congenital cases, i.e. lip repair followed by orthodontic treatment and speech therapy. The cleft lip deformity of the columella and of the right nostril was satisfactorily corrected (Fig. I, B) and the function of the orbicularis oris muscle restored. 1 T h e boy was treated b y t h e a u t h o r w h e n he was still w i t h t h e Kieferklinik, U n i v e r s i t y Hospital, Hamburg.
By OTTO .B. KRIENS, M.D., D.D.S.
Kieferklinik der Universitiit Erlangen-Nitrnberg, Glitckstr.zG 8520 Erlangen, Germany. CLEFT lips of non-congenital origin are rare. Trauma, for example from traffic accidents or dog bites, is the usual cause. An unrepaired traumatic cleft lip will only be observed in areas without surgical aid available or when cruelty or neglect of a child occurs as in the present case. A careful search of the literature did not reveal a similar deformity.
A
D
FIG. I
A. " Cleft lip " on admission. B. Post-operative result. C. Intra-oral view exposes extensive scars in the maxillary vestibule, deviation of the columella and malalignment of teeth. Note the protrtision of the right upper incisor into the area of the lip defect. D. Lip in whistling position shows cleft lip deformity of the right nasal entrance, base of columella, philtrum, and slight shortness of lip in the cleft area. There is a scar in the lower lip vermilion (see A). 69
7°
BRITISH
J O U R N A L OF P L A S T I C S U R G E R Y
Case R e p o r t . - - T h e boy 1 was referred from a public health physician to have a repair of his cleft lip which was believed to be congenital. The boy is the first of twins born into a ruined family life. He lived in different children's homes for the first three years of his life. Then he was returned to his divorced mother and stayed with her until he was 12 years of age when, being deserted by the mother, he had again to be taken to a children's home. At that time a cleft lip was recorded in the admission papers. When asked about the deformity of his
FIG. 2 Partial lip cleft with left upper medial incisor being protruded through the cleft.
upper lip, the boy believed it might have resulted from a fall downstairs as he had once been told. It was impossible to discover whether his wound healed by second intention because of neglect to obtain surgical treatment or whether his mother, possibly because of a criminal infliction of the wound, did not seek it. Clinical findings.--The vermilion and adjacent lip white were cleft in about a quarter of the vertical length of the upper lip. The medial portion of the vermilion was puUed up towards the end of the defect, whereas the lateral stump seemed to hang down. There was an atrophic white vertical scar, 9 mm. in length, lateral to the right philtrum edge (Fig. I, A). The impression of a congenital partial lip cleft was simulated by the columella and philtrum deviating to the unaffected side, especially during function (Fig. I, D). However, broad scars on the mucosal side of the lip and in the fornix of the oral vestibule along with the scar in the lower lip vermilion suggested a traumatic mtiology (Figs. I, c and D). The defect in the orbicularis otis muscle seemed to have contributed to the malposition of the first right upper'incisor (Fig. I, D). A similar protrusion of a maxiUary incisor can be observed occasionally in congenital cases who have not had their cleft lip repaired prior to the change of dentitions (Fig. 2). Treatment was similar to that in congenital cases, i.e. lip repair followed by orthodontic treatment and speech therapy. The cleft lip deformity of the columella and of the right nostril was satisfactorily corrected (Fig. I, B) and the function of the orbicularis oris muscle restored. 1 T h e boy was treated b y t h e a u t h o r w h e n he was still w i t h t h e Kieferklinik, U n i v e r s i t y Hospital, Hamburg.