EMBRIOLOGY CLEFT ( smit and grap hal 185 )

A unilateral cleft lip results from failure of fusion of the

medial nasal prominence and maxillary prominence on one

side (Fig. 21.9A).
A bilateral cleft lip results from failure of
fusion of the merged medial nasal prominences with the maxillary
prominence on either side (Fig. 21.9B). As a result, the
merged medial nasal prominences (globular process) are often
quite prominent, as they are not restrained by attachment to
the maxillary prominences laterally.
This is manifest at birth, as in a patient with a complete bilateral cleft lip and anterior
overprojection of the premaxilla and prolabium.
Laterally, the maxillary and mandibular prominences join
at the lateral commissure of the mouth.
Failure of union of
these prominences produces macrostomia, as a result of a cleft
of the lateral commissure (Fig. 21.9F). This is a number 7 facial
cleft by the Tessier classification (7). Another rare facial cleft is
a median cleft lip (Fig. 21.9D), which is caused by incomplete
merging of the medial nasal prominences in the midline and
is usually associated with deep midline furrowing of the nose,
resulting in various degrees of nasal bifidity. This condition
is also described as a number 0 cleft by the Tessier classification

(7). Failure of the mandibular prominences to unite in

the midline produces a central defect of the lower lip and chin
(Fig. 21.9E), which is referred to as a number 30 cleft by the
Tessier classification (7).