Albrecht[19] records a most interesting case in a newly born pup (Fig. 21) of double clefts extending from the lip margin upwards not only into the nostril, but also towards the eye on either side, _i. e._ a double associated harelip and facial cleft. The specimen is taken from the Royal Veterinary College of Brussels. [Illustration: FIG. 21.—Front view of a young puppy’s head from a preparation in the Veterinary College of Brussels, showing double harelip with double partial facial cleft. (After _Albrecht_.) _a._ Central portion of upper lip, corresponding to internal nasal process. _b._ Ala nasi, corresponding to external nasal process. _c._ Outer portion of upper lip, from superior maxillary process. _d._ Harelip cleft. _e._ Facial cleft.] [Illustration: FIG. 22.—Macrostoma, showing the cleft in the cheek prolonged upwards and backwards by a reddish cicatrix to a lateral loss of substance of the cranial wall. (_Sutton._)] MACROSTOMA _Or commissural harelip_ (French, _bec-de-lièvre genien_; German, _Quere Gesichtsspalte_, _Wangenspalte_, or _Grossmaul_) is a less uncommon condition, evidenced by an increased transverse diameter of the mouth. The oral aperture extends into one or both cheeks, and, if unilateral, is more frequently on the right side. The cleft extends upwards and backwards towards the auditory meatus, and sometimes towards the temple to a variable extent. It may merely be manifested by a slight increase in the breadth of the mouth, or may extend to a considerable distance, as in a case reported by Rynd,[20] where the mouth-opening extended as far as the first molar on the right side, and to the last molar on the left. Sutton[21] has published drawings of a child (Fig. 22) in which a very large cleft existed, the angles of which gradually passed into a red cicatrix. This scar ended in a gaping recent wound over the temporal region, extending to the dura mater, and through this, after death, the convolutions of the brain were visible. The condition was symmetrical, and he suggests that the wound in the skull was probably brought about during parturition. The same author records a condition the very opposite of this, where the defective closure of maxillary and mandibular processes was reduced to a minimum, the deformity amounting to nothing more than a fistulous opening through the cheek, with a small tumour representing an accessory auricle just in front of the tragus. Roulland[22] has recently reported an instructive case in which double macrostoma existed with accessory auricular appendages, but this was also complicated with an entire absence of the middle ear and of the Eustachian tube, with defective development and absence of the temporo-maxillary joint on the left side. Such a deformity is probably to be explained by an excessive obliteration or partial development of the maxillo-mandibular cleft at its posterior extremity, and a defective obliteration of the same anteriorly.