A consideration of the LeMesurier technic of single harelip repair with a new concept as to its use in incomplete and secondary harelip repairs.
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The various statements of medical historians concerning harelip surgery in Ancient China have been studied with the help of eminent historians and based on reliable documents. The text of the Chin Shu adds a very important contribution to our knowledge of ancient cleft lip repair: the first use of the word harelip, the first short but rather accurate description of the operation and the postoperative care, and the social and psychological impact of facial disfigurement. The assertion regarding Fang Kan as the doctor of lip repair during the T'ang Dynasty turned out to be completely erroneous. Fang Kan was a poet whose life and lack of acceptance were dominated by his external appearance: a harelip deformity that was operated on late in life.
Mothers of children who need reconstructive operations for defects present at birth are likely to feel guilty, particularly if the pregnancy was unwanted. The physician treating the child is in a position to reassure the mother and assuage her guilt. To the child, the meaning of a surgical experience depends not on the type or seriousness of the actual operation, but on the type and depth of imaginings which it stimulates. For children between two and four, the anxiety of separation from the mother is greater than that aroused by the anesthetic. A good relationship with the mother will insulate the child against many traumatic events.A surgical operation is an important and stressful experience for a child, activating the great childhood fears of abandonment, of mutilation, and of death. Very frequently, children with harelip and cleft palate, by the time definitive restorative surgery is contemplated, have had emotional experiences that make them more than usually vulnerable to the harmful effects of operation. If the child can discuss the products of his imagination about the operation and have them corrected by someone he trusts, the total response will be more adequate. Talking out and playing out help prevent the development of excessive and harmful emotional reactions.
The authors classify the thymic image on the pre-operative chest films of 114 cases of harelip babies under 2 years of age into 5 types and divide the size of thymus according to the cardiothymic thoracic ratio (CT/T) into 4 classes. The thymic prominence rate is 93.9%. There is marked variability in the size and shape of thymus, no definite normal standard could be found. In 6 preoperative cases, stress involution and regeneration induced by the administration of steroids has been observed. Whether or not the normally large thymus found on the chest film in baby-hood influence the safety of operation was discussed.
The anatomy of harelip is described, as well as attempts to correct it--bilaterally and unilaterally--in a manner producing normal nasal tips.
With the aid of micro-laser irradiation, in a total of 156 chick embryos unilaterally (a part of) the cephalic neural crest paralleling the posterior portion of the prosencephalon and mesencephalon, was eliminated. As a result of this treatment, 2 out of 22 embryos, studied 24 hours after irradiation, showed a considerable degree of underdevelopment of the mesenchyme in the homolateral first branchial arch. At the age of 7 days (6 days after irradiation) 11 of the 44 surviving embryos proved to have developed a homolateral harelip condition. In 2 of these embryos, a wide palatal cleft was observed as well. These results demonstrate that facial clefts may develop as a result of a local deficiency of neural crest cells.
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