Volume 1

A text-book of pathological anatomy and pathogenesis / by Ernst Ziegler ; translated and edited for English students by Donald MacAlister.

  • Ernst Ziegler
Date:
1885-1887
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of pathological anatomy and pathogenesis / by Ernst Ziegler ; translated and edited for English students by Donald MacAlister. Source: Wellcome Collection.

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    8. Fissural malformations depending 011 imperfect union of tho branchial arches. (1) Cie ft palate (Cheilo-gnatho-palatoschisis). In this de- formity a fissure extends from the upper lip through tho alveolar process of the superior maxilla, the superior maxilla itself, and the palate. The hard palate is cleft along its line of junction with the vomer; in the soft palate the fissure passes along the middle line; in the alveolar process it goes between the exterior incisor and the canine tooth. If the fissure is bilateral, there ap- pears a yawning aperture above the mouth, which is wider and deeper according to the stage at which the development of the vomer, intermaxilla, and lip was arrested. Very often the fissure affects only the upper lip (Labium leporinum, hare-lip); less often the palate alone, or the palate and superior maxilla. The slightest degree of fissure is probably represented by a slight notch or scar in the upper lip, or in another direction by a bifurcation of the uvula. Even slight fissures of this kind may however be bilateral. These varieties of fissure depend on an imperfect union of the superior maxillary and palatal processes of the first branchial arch with the nasal process of the frontal, the intermaxilla, and the vomer. This union should normally take place in the third month. In some cases the cause of the cleft has beeil found to be a morbid adhesion of the amnion to the face. The malformation may be hereditary. (2) Schistoprosopia and Aprosopia. If the development of the first branchial arch, and of the nasal process of the frontal, be still more seriously interfered with, we have instead of the middle of the face a mere gaping cavity. Cleft-palatc has become cleft-face. In extreme cases, eyes and nose being also absent, there may be no face at all. (3) Agnathia, or absence of the inferior maxilla, is due to arrested development of the inferior maxillary process of the first branchial arch. In consequence of this deficiency the lower half of the face seems cut away, and the ears coine almost into contact with each other (Synotia). In special instances the superior maxillary process is also rudimentary, and the malformation is accompanied by Cyclopia, with imperfect cerebral development. (4) In consequence of the partial persistence of a branchial cleft, we sometimes meet with fissure of the neck, the so-called Fistula colli congenita. This oftenest takes the form of an opening a little above and extemal to the sterno-clavicular joint: more rarely the opening is in the middle line, or higher up in the neck. Generally there is but one opening; sometimes however there are two symmetrica]ly placed. The fistular canal is for the most part narrow and lined with mucous membrane; it passes