habit of expelling the air through the nose.

Before the operation is undertaken, the child must be got into the
best possible condition; and arrangements must be made for its
constant supervision by a competent nurse. Success depends largely on
the avoidance of infective complications, and on absence of tension
between the rawed surfaces that are brought into apposition. More than
one operation is sometimes required to effect complete closure of the
cleft.

_Voice Training._--The treatment of cleft palate does not cease with a
successful operation; the importance of voice training must be
explained to the parents. The child must be taught, in speaking, to
send the stream of air through the mouth, instead of through the nose.
If the soft palate is not sufficiently large and mobile to shut off
the mouth from the nasal cavity, little improvement in speaking can be
looked for.

In _adolescents_ and _adults_, if the cleft is wide and the soft
tissues of the palate are thin and atrophied, better physiological
results may be obtained by the use of an artificial obturator or
velum. With the aid of the dentist a plate of vulcanite or gold is
fitted to the teeth and kept in position by suction.

#Other Congenital Deformities of the Face.#--_Macrostoma_ is an
abnormal enlargement of the mouth in its transverse diameter, due to
imperfect fusion of the maxillary and mandibular processes.

_Microstoma_ is due to excessive fusion of the maxillary and
mandibular processes. In some cases the buccal orifice is so small as
only to admit a probe.

_Facial cleft_ is due to non-closure of the fissure between the nasal
and maxillary processes. It passes upwards through the lip and cheek
to the lateral angular process of the frontal bone.

_Mandibular cleft_ occurs in the middle line of the lower lip, and may
extend to, or even beyond, the chin; it is due to non-union of the two
lateral halves of the mandibular arch.

These various deformities are treated by plastic operations carried
out on the same principles as for hare-lip.

_Fistulae of the Lower Lip._--Two small openings, about the size of a
pin's head, are occasionally met with on the free border of the lower
lip, near the middle line. On passing a probe, each is found to lead
into a narrow cul-de-sac, which runs for about an inch laterally and
backwards under the mucous membrane. Watery, saliva-like fluid exudes
through the openings. These fistulae frequently occur in sever