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).