Question

Based on the clinical photographs shown, identify the facial anomaly depicted (bilateral defect of the upper lip with associated nasal deformity).

• A. Bilateral cleft lip
• B. Midline cleft lip
• C. Cleft palate
• D. Oblique facial cleft

Hint:

Two paired defects flanking the midline with a central premaxilla.

Answer 1

The Correct Option is A

Step 1: Recall the embryology. The upper lip forms by fusion of the two maxillary prominences with the merged medial nasal prominences. Failure of fusion on both sides produces a bilateral cleft lip, typically with a protruding premaxilla and a short columella.

Step 2: Match to the photograph. The clinical grid shows clefts on both sides of the midline of the upper lip with the central premaxillary segment isolated - the classic appearance of bilateral cleft lip.

Step 3: Eliminate the others. Midline cleft lip is rare, results from failure of merging of the medial nasal prominences and is associated with holoprosencephaly/hypertelorism - the defect is central, not paired. Cleft palate involves the roof of the mouth (palatal shelves), not the lip surface. Oblique facial cleft (Tessier cleft) runs obliquely from the lip toward the eye along the naso-optic groove and is extremely rare.

Step 4: Conclude. Paired defects flanking the midline of the lip with an isolated premaxilla = bilateral cleft lip.

Key fact: Failure of fusion of the maxillary and medial nasal prominences on both sides gives bilateral cleft lip, the most likely answer for paired upper-lip clefts.