A more aggravated condition has been dissected by Witzel (in the Rostock Collection). Behind the cleft in the upper lip was found a median division of the premaxilla, each half of which was firmly united to the adjacent superior maxilla. The vomer was single, but broader than usual, and the palate cleft throughout; the two halves of the nose were bounded internally by separated plates of the divided cartilaginous nasal septum. There was also a defect of the frontal bone giving rise to a meningocele. This flattening of the nose, combined with separation of the anterior nares, gave such an appearance to the face as seemed to warrant the term “dog’s nose” (Doggennase) which has been applied to it.[15] FACIAL CLEFTS (German, “_Schräge Gesichtsspalte_”). [Illustration: FIG. 18.—Oblique facial cleft, or rather cicatricial deformity of face along the line usually traversed by such a cleft. (_Tillmanns_, after _Kraske_.)] [Illustration: FIG. 19.—Facial cleft in a child, implicating the lower lid and eye, and with a development of accessory teeth along the cleft margins. (_Tillmanns_, after _Hasellmann_.)] [Illustration: FIG. 20.—Double facial cleft with macrostoma. (_Tillmanns_, after _Guersant_.)] These are seldom seen, but a sufficient number are now recorded and figured to enable us to study the nature of the defect. Sir W. Fergusson seems the only English surgeon who has observed this rare condition, the majority of recorded cases hailing from Germany or France. As we shall see hereafter, this defect is due to the non-closure of the cleft between the outermost part of the intermaxilla and the maxilla itself, and occupies the position which was claimed up to recent years as that of an ordinary harelip. In several of the cases noted red cicatrices (Fig. 18) rather than actual clefts (Figs. 19 and 20) were present. The defect begins at the free margin of the upper lip, and usually at the spot whence starts the ordinary harelip cleft; but occasionally from the angle of the mouth. It then trends upwards and outwards, leaving the nose entire, and skirts round the ala nasi to reach its upper limit at the middle of the lower eyelid which is cleft, or at the inner canthus. The eye itself may show a coloboma iridis, usually downwards and inwards. The facial skeleton may be divided or not; sometimes a large opening into the antrum exists (Hasellmann,[16] Kraske[17]). No incisor teeth are developed on the outer side of the cleft, the first tooth seen being the canine. On the inner border of the cleft lip there is usually a marked frænulum, often smaller, however, than the normal median frænum. This deformity may be unilateral or bilateral (Guersant, Meckel), more frequently the former; and is not uncommonly associated with macrostoma of the same or opposite side of the face (Guersant, Pelvet[18]), as seen in Fig. 20.