CONGENITAL HEALED CLEFT-LIP

Congenital ''healed'' cleft lip (CHCL) is an unusual anomaly including a paramedian ''scar'' of the upper lip, which appears as if a typical cleft lip has been corrected in utero. The CHCL is frequently associa ted with an ipsilateral notch in the vermilion, and ''collapsed'' nost ril. Twenty-five CHCL cases are presented, eighteen of which were an i solated malformation found among the 3,950,715 births examined in two similar birth defect registries: ECEMC in Spain and ECLAMC in Latin Am erica. Like open cleft lip, of which it seems to be a variant, CHCL is most frequently seen among males (14/18 isolated cases), it preferent ially affects the left side (10/18 cases), and it segregated together with cleft lip in one family. The five CHCL cases with other congenita l anomalies included: two cases with hydrocephalus, two VACTERL associ ations, and one atypical oblique facial cleft infant with single umbil ical artery. CHCL may result from a defective fusion of the frontonasa l and maxillary processes (before week 7 of embryonic life), or from a spontaneously repaired open cleft lip, later on. In either way, these cases heal with a visible scar, and the pre-occurrence of CHCL in two families suggests a familial predisposition to this phenomenon. (C) 1 995 Wiley-Liss, Inc.