CC BY-NC-ND 4.0 · Indian J Plast Surg 2009; 42(S 01): S4-S8
DOI: 10.1055/s-0039-1699370
Review Article
Association of Plastic Surgeons of India

Cleft lip: The historical perspective

S. Bhattacharya
Department of Plastic Reconstructive and Aesthetic Surgery, Sahara India Medical Institute, Lucknow, India
V. Khanna
Department of Plastic Reconstructive and Aesthetic Surgery, Sahara India Medical Institute, Lucknow, India
R. Kohli
Department of Plastic Reconstructive and Aesthetic Surgery, Sahara India Medical Institute, Lucknow, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2020 (online)


The earliest documented history of cleft lip is based on a combination of religion, superstition, invention and charlatanism. While Greeks ignored their existence, Spartans and Romans would kill these children as they were considered to harbour evil spirits. When saner senses prevailed Fabricius ab Aquapendente (1537–1619) was the first to suggest the embryological basis of these clefts. The knowledge of cleft lip and the surgical correction received a big boost during the period between the Renaissance and the 19th century with the publication of Pierre Franco's Petit Traité and Traité des Hernies in which he described the condition as “lièvre fendu de nativitè” (cleft lip present from birth). The first documented Cleft lip surgery is from China in 390 BC in an 18 year old would be soldier, Wey Young-Chi. Albucasis of Arabia and his fellow surgeons used the cautery instead of the scalpel and Yperman in 1854 recommended scarifying the margins with a scalpel before suturing them with a triangular needle dipped in wax. The repair was reinforced by passing a long needle through the two sides of the lip and fixing the shaft of the needle with a figure-of-eight thread over the lip. Germanicus Mirault can be credited to be the originator of the triangular flap which was later modified by C.W. Tennison in 1952 and Peter Randall in 1959. In the late 50s, Ralph Millard gave us his legendary ‘cut as you go’ technique. The protruding premaxilla of a bilateral cleft lip too has seen many changes throughout the ages OE from being discarded totally to being pushed back by wedge resection of vomer to finally being left to the orthodontists.


  • 1 Converse JM, Hogan VM, McCarthy JG. Cleft lip and palate. In: Converse JM, editor. Reconstructive Plastic Surgery. 2nd ed. Philadelphia: Saunders; 1977. p. 1930.
  • 2 Dorrance GM. The operative story of cleft palate. Philadelphia: Saunders; 1933.
  • 3 Oritz-Monasterio F, Serrano RA. Cultural aspects of cleft lip and palate treatment. In: Grabb WC, Rosenstein W, Bzoch KR, editors. Cleft Lip and Palate. Boston: Little Brown; 1971.
  • 4 Skoog T. A head from ancient Corinth. Scand J Plast Reconstr Surg 1969;3:49-53.
  • 5 Magnus O. (Archibiscopus Upsaliensis) Historia de gentibus septentrionalibus, De Leporum Varietate, Roma: 1535.
  • 6 Keating JM. Cyclopaedia of the diseases of the children. Philadelphia: Lippincott; 1889.
  • 7 Fabricius ab Aquapendente G. De Formatio Fetu. Pasquali, Padua: 1600.
  • 8 Blandin PF. De l'Autoplastie ou Restauration des Parties du Corp qui ont ete Detruites a la Faveur d'une Emprunt fait a d'autres Patries plus ou moins Eloignees. Thesis, Urtubie, Paris: 1836.
  • 9 Blandin PF. Autoplastie. Jour de Conn Med Chir 1837;14:45.
  • 10 Blandin PF. Operation to remedy a division of the velum palati or cover of the palate. New York J Med 1838;10:203.
  • 11 Meckel JF. Beitrage zur Gesichischte des menschlichen Foetus. Beitr Verlag Anat 1808;1:72.
  • 12 His WE. Ueber die Aufgaben und Zielpunkte der wissenschaftlichen Anatomie. Leipzig: 1872.
  • 13 His WE. Beobachtungen zur Gesichichte und Gamennbildung beim menschlichen Embryo. Kgl Akad Wiss 1901.
  • 14 Yperman J. La chirurgie de maitre Yperman mise au jour et annotee par JMF Carolus. Gand: F and D Gyselynch; 1854.
  • 15 Franco P. Traite des Hernies. Lyons: Thibauld Payan; 1561.
  • 16 Morse WM. Chinese Medicine. New York: Hoeber; 1934. p. 129
  • 17 Wu LT Wong. History of Chinese Medicine. Shanghai: Mercury Press; 1936.
  • 18 Sterpellone L, El-Sheikh MS. La medicina Araba. Milano: Ciba Geigy; 1995.
  • 19 Pfolsprundt H von. Buch de Bűndth-Ertsnei von H von Pfolsprundt Brunder de deutschen ordens 1490. Herausgegeben von H. Haeser und A Middledorpf, Reimer, Berlin: 1868.
  • 20 Brunschwig H. Dis ist das Buch der Chirurgia: Hautwirckung der wund artz. H Schonsperger, Ausburg: 1497.
  • 21 Pare A. Les oeuvres de M Ambroise Pare. Paris: Chez Gabriel Buon; 1575.
  • 22 Mirault G. Deux lettres sur l'operation du bec-delievre. J Chir 1844;2:257.
  • 23 Veau V. Bec de Lievre. Hypothese sur la malformation initiale. Ann Anat Pathol Paris 1935;12:389.
  • 24 Roonhuysen H van. Historischer heil-curen in zwei theil verfasste. Michael und Johann Freidrich Endtern, Nurnberg: 1674.
  • 25 Cooper A. The lectures of Sir Astley Cooper FRS on the principles and practices of surgery, 3 vol. Underwood Lectures IV, XXIX and XXXV, London: 1824, 1825, 1827.
  • 26 Leclerc MG. The complete Surgeon: or the whole art of surgery explain'd in a most familiar method. In: Freeman W, Walthoe J, Goodwin T, Motton M, Parker R, editors. London: 1701.
  • 27 Ranzi A. Lezioni di Patologia Chirurgica date nella R Universita di Pisa. Vol 3. Gazzini e Giannini, Firenze: 1860OE1863. p. 419.
  • 28 Simon G. Ueber die Anwendung mehrfacher Nahtreien zur Vereininuus einer Wunde. Wunderl Arch 1859;3:312.
  • 29 Dieffenbach JF (1836) Memoires sur quelque nouvelle methods obtenir la gueisondes ouvertures contre nature a l'extremite anterieure libre de l'urethre chez l'homme. Gaz Med Paris: 1836. p. 802.
  • 30 Hagerdon WH. Operation for harelip with zigzag suture. Zentralbl Chir 1892;19:281.
  • 31 Le Mesurier AB. A method of cutting and suturing the lip in the treatment of complete unilateral clefts. Plast Reconstr Surg 1949;4:1-12.
  • 32 Tennison CW. The repair of unilateral cleft lip by the stencil method. Plast Reconstr Surg 1952;9:115.
  • 33 Randall P. Triangular flap operation for unilateral clefts of the lip. Plast Reconstr Surg 1959;23:331.
  • 34 Veau V. Bec de Lievre. Hypothese sur la malformation initiale. Ann Anat Pathol Paris 1935;12:389.
  • 35 Skoog T. The use of periosteum and Surgicel for bone restoration in congenital clefts of the maxilla. Scand J Plast Reconstr Surg 1967;1:113.
  • 36 Millard RC. Cleft Craft. Vol. 1OE3. Boston: Little Brown; 1976.
  • 37 Manchester WM. The repair of bilateralcleft lip and palate. Br J Surg 1965;52:878-82.
  • 38 Estlander JA. Eine method aus der einen lippe substanzverluste der anderen zu ersetzen. Arch Klin Chir 1872;14:622.
  • 39 Faltin R. History of plastic surgery in Finland. Finsk Lak Sallsk Handl 1937;80:97.