Probably the safest time is not much earlier than the second month in very strong children, the fifth in weakly ones, up to the commencement of the first dentition; and when once dentition has commenced it is not so safe to operate till it is over. Prior to dentition the operation is attended with rather more risk, but again, if delayed, there is great risk that the teeth do not come in properly. 2. With regard to the most delicate part of the operation, _the management of the prolabium_.--Some are satisfied, and I believe rightly, with careful apposition by a silk suture after a _sufficient_ amount of the edges has been removed; others have proposed various plans to obviate any risk of an angle remaining. Malgaigne proposes to retain a small portion of the parings of the edge to make small flap at each side; Lloyd a single one from the long half of the lip, and brings it up under the opposite one, securing it with a stitch. FOOTNOTES: [95] Operation for formation of a new nose from the cheeks; A A, flaps approximated in middle line; B B, outer part of bed of flaps stitched up; C C, triangle at each side left to granulate. [96] _The Restoration of a Lost Nose by Operation_, p. 57; an excellent monograph on the subject. [97] Operation for formation of a new nose from the forehead:--_a_, prominence of flap which is to be used as septum; _b_, left-hand corner of flap, which is twisted and fastened at _c_; _d_, one of the tubes or quills over which the nose is moulded.--(_Modified from Bernard and Huette._) [98] Syme's _Observations in Clinical Surgery_, p. 132. [99] Diagram of V-shaped incision; A B A, dots showing points for sutures. [100] Diagram of incision for scooping out a shallow tumour by scissors. [101] Diagram of incisions:--C A C, outline of incision for removal; C A D, outline of flap on each side; B, prominence of chin; C C, dotted lines, showing incisions to enlarge mouth, if required. [102] Diagram of flaps in position:--A A, corners of flaps brought up and approximated by _silver_ sutures; C C, new lip got by lateral incisions, skin and mucous membrane being united by _silk_ threads; E E, gap left to granulate. [103] Fig. XXIII. shows the incision bounding the cleft. [104] Fig. XXIV. shows the diamond-shaped wound before the sutures are applied. [105] Diagram of operation for double harelip:--_a_, stitch through both sides and wedge-shaped portion, which also aids the septum; _b_, other stitches approximating edges. [106] Diagram of double harelip, with projecting bone:--_a_, central piece of lip, dotted lines showing incision; _b_, projecting bone bearing teeth, which are generally small and stunted. CHAPTER VII. OPERATIONS ON THE JAWS.