Abdul Rashid Khawja  ( Department of Surgery, Rawalpindi Medical College, Rawalpindi. )
Abdul Rashid Chaudhry  ( Department of Surgery, Rawalpindi Medical College, Rawalpindi. )
ljaz Ahmed  ( Department of Surgery, Rawalpindi Medical College, Rawalpindi. )
Nasir Saeed  ( Department of Surgery, Rawalpindi Medical College, Rawalpindi. )

Two cases are reported. One child was male and other a female. Anamoly is rare. This anamoly was found in 2 out of 500 cases (0.4%) in the present series of cleft lip, (1979-1984). Repair of lip is easy as compared with other cleft lip reconstructions(JPMA36.43 1998).

CASE 1
l.N. female full term, 10 Lbs at birth, child of non consanguinous parents. Baby was first seen on the third day after birth, No family history of cleft lip or other anamolies was present. Mother had not taken any drug, had not suffered ill­ness or radiatinn and had not been vaccinated, during pregnancy.
The child had a median cleft of upper lip. There was also a clefi of alveolus and a cleft of hard and soft palate Figures 1,2).


An anterior men­ingocele, arising from cribriform plate, presented itself in Thasopharynx through the cleft palate. X-Ray of the base of skull showed a linear defect in the median plane of the anterior cranial fossa. There was no evidence of holoprosencephally. In this case we found complete median assymetry, starting from the lip to base of skull. Since no facilities for CAT scan and transillumination were available, these were not carried out.
Lip cleft was repaired at the age of 12 weeks. Palate repair was postponed till the correction of meningocele.
CASE 2
U.K. was an II month old, male, healthy child of consanguinous parents, product full term and normal delivery. No history of medication, radiation or illness of the mother during pregnancy was present. Median cleft (Figure 3)

was noticed by mother at birth, and her physician had referred the child to us for correction at the age of II months. Mother had noticed an opacity in the left eye, and the opthalmologist was treating the case as aniridia and lenticular opacity. Right eye was normal.
There was partial cleft of alveolus, no other abnormality was detected. Cleft lip and alveolus were corrected with good result.

The first case of median cleft associated with other abnormalities was reported in 1909.¹ Median cleft lip is a very rare condition and is due to failure of downward growth of mesoderni in the median nasal process.² We have the above 2 cases in our .series of 500 cases treated in past 6 years. Five cases have been reported only pre­viously of median cleft associated, with poly­dacyly, syndactyly and toe anamolies.³
The presentation is unique in the sense that both cases presented with associated abnormalities of anterior process of the face and of anterior cranial fossa. No other abnormalities were detected in these children. Both these children were mentally alert. Milestones of growth and development were normal. There was no sign of mental deficiency in these children.
In view of the clinical findings of frontal assym et ry and associated holop rosencephaly, we intended to confirm it with CAT scan and tran­sillumination tests, but these facilities were not available.⁴ Radiographs of base of skull showed a linear defect in the linear plane of anterior cranial fossa.⁵
Repair of median cleft is easy, we used a bilateral median longitudinal incisions, with bilateral lateral advancement 3mm above the vermillion border. Results were good.

1. Thurston, E.D. A case of median hare-lip asso­ciated with other malformations. Lancet, 1909; 2:996.
2. Christie, A.B. and Mustarde, J.C. Surgery in infancy and childhood. 3rd ed. Edinburgh, Churchill  Livingstone, 1974, p. 428.
3. Christophorou, M.N. and Nicolaidou, P. Median cleft lip, polydactyly, syndactyly and toe anom­alies in a non-Indian infant. Br. J. Plastic Surg., 1983; 36:447.
4. Burian, F. Syndromes of the head and neck. Edited by Gorlin, R.J. and Pindborg, J.J. 2nd ed. New York, Mc Graw-Hill, 1976.
5. Khoo, C.T.K. and Sand, M.N. Median cleft of the upper lip in association with bilateral hexadactyly and accessory toes. Br. 3. Plastic Surg., 1980; 33:407.