Roger L. Crumley, MD: The patient for discussion today was a 3-month-old girl with a complete unilateral cleft lip on the left. The child was the product of a normal gestation. There was no maternal drug usage in pregnancy, and no family history of cleft lip or palate. She was the firstborn child and, as is often the case, the cleft was a complete surprise. Labor and delivery were uncomplicated, and the Apgar score was 10 at the time of birth. On physical examination, there was a cleft of the lip and the alveolus on the left side (Fig 1). In addition, the child had the typical unilateral cleft lip nasal deformity, in that the base of the ala on the cleft side was inferiorly and posteriorly displaced. Also, the base of the columella was deviated to the noncleft side. (Of course, the reason for this is that the anterior