CASE OF HARELIP COMPLICATED WITH 
INTERMAXILLARY FISSURE. 
Professor of Orthopaedic Surgery, Medical Department, 
Columbian University. 
A. R. SHANDS, M. D. Washington, D. C., 
[Reprinted from Virginia Medical Semi-Monthly, March 12, 1897.] 
Frank Bel], Age 12. Diagnosis: Single hare- 
lip with fissure of superior maxillary bone at 
right intermaxillary junction. Admitted to 
the Orthopaedic Service at Emergency Hospital 
and Central Dispensary, Dec. sth, 1896. 
In presenting this case, it is not intended to 
describe the etiology of harelip, but simply to 
call attention to several peculiar features in 
this case and to describe the operation per- 
formed. Photograph No. 1 shows quite well 
the depth of the bony fissure which is bounded 
by the first molar on the right and by right cen- 
tral incisor on the left, extending to junction of 
the superior maxilla with palate and nasal 
bones in shape of an inverted “A”l depth of 
fissure being about one inch. The result of 
this non-intermaxillary union was that the 
alveolar arch grew upwards at an angle of 
about forty-five degrees from the first left bi- cuspid, pressing the nose to the left, which is 
well shown in photographs 1 and 2. 
The right bicuspids were absent and the cen- 
tral incisors poorly developed. The central 
incisors fail to approximate with their fellows 
of inferior maxilla by about one inch, and one- 
half inch respectively. It should be mentioned 
that there was no cleft palate. 
This bony prominence with the right cen- 
tral incisor extending into the nostril prevented 
the approximation of the fragments of the lip 
in a satisfactory position; hence it was decided 
to move this obstacle by sawing it off, which 
was done by first dissecting back the gum tissue 
covering it, then making an incision with a 
saw from the left canine obliquely across to the 
apex of the “A” fissure already described. 
The incised bony surface was then covered 
with flaps of the gum tissue previously dis- 
sected back. 
Thus the first part of the operation being 
completed, the next step was the approximation 
of the fragments of the lip. To avoid tension 
as much as possible, and to get best apposition, 
the labial connection with maxilla was freed 
well up under the cheek and back to the angles 
of the mouth. The right flap was pared from 
the apex of the cleft along its entire vertical 
length, and for about one-half inch on its hori- 
zontal surface, cutting away about one-eighth 
inch of the true skin. The left flap was treated 
in same way, except that the paring was not 
severed at its lower connection; when the sutures were put in, enough of this paring was 
saved to cover the under pared surface of the 
right flap. 
The wound was closed with silk sutures, no 
pins being used. Dressing consisted of a good 
coating of an emulsion of iodoform and collo- 
dion and sterilized gauze, held in place by a strip 
of adhesive plaster extending around the neck 
just under the ears. The adhesive plaster served 
the double purpose of holding the dressing in 
place and at the same time prevented any un- 
due tension on the sutures. The iodoform 
and collodion emulsion served to protect the 
wound from the dirty secretions from the 
nostrils. 
The sutures were removed on the fifth day, 
when perfect primary union was found to exist; 
at the same time a light dressing was applied, 
held by a strip of adhesive plaster applied as 
already described; this adhesive plaster sup- 
ported the wound without tension until the 
eighth day, when all dressing was removed and 
photograph No. 3 was taken. 
A plate with false teeth to replace the miss- 
ing teeth is needed to improve his mouth for 
mastication, and at the same time it would have 
a cosmetic effect by holding the lip up; photo- 
graph No. 3 shows that the lip is a little de- 
pressed on the right. 
In closing this report, I wish to render thanks 
to Dr. Arthur A. Snyder for the valuable assis- 
tance he rendered me while operating on this 
case. 
1305 H. St., N. W. Photograph No. 1. Photograph No. 2 Photograph No. 3