2. _Nélaton’s method_ (Figs. 48 A and B).—In this no tissue is removed, but the margin is freed by a semicircular incision skirting the cleft and extending through the whole thickness of the lip. The centre of the fissure is then drawn down, and the opening thus created is brought together laterally so as to cause the lower portion to protrude as a prolabium. It is only suitable for very mild cases of harelip where the nostril is not involved, and has been adopted in the secondary treatment of the 𝖵-shaped notches, the results of previous operations. It will be noted, however, that the prolabium in this case consists mainly of cutaneous tissue, and that there must necessarily be an unsightly break in the red margin of the lip, which makes it a most undesirable proceeding. [Illustration: FIG. 48.—Nélaton’s operation. No tissue removed, but the loosened margin pulled down and sutured.] 3. _Malgaigne’s operation_ (Figs. 49 A and B) was suggested for unilateral harelip where the fissure does not extend into the nostril. No tissue is removed, but flaps are turned down from the apex of the cleft on either side, the incision stopping at the red margin of the lip. Knife or scissors may be used. The flaps are drawn down and united to form a prolabium, whilst the raw surfaces, necessarily left above, are united from side to side. The same objection applies to this as to Nélaton’s operation, viz. the break in the red margin of the lip caused by the interposition of integument. [Illustration: FIG. 49.—Malgaigne’s operation. No tissue removed; cleft margins turned down to form a prolabium.] 4. _Giraldés’_[77] _or the mortise operation_ (Figs. 50 A and B) is a somewhat complicated proceeding. Taking a left-sided unilateral cleft for illustration, a flap (_a_) is cut on the right side from below upwards, starting from the muco-cutaneous junction, and remaining attached by its base to the root of the nose. The portion of red lip margin below this is removed by an oblique incision (_c_), and so prepared for receiving a flap from the other side. On the left side of the cleft, a flap (_b_) is made by cutting from the ala nasi downwards to the muco-cutaneous junction, leaving it attached below; and in addition a transverse incision outwards is made from the same starting-point, skirting the nostril if necessary. The right-hand flap (_a_) is turned up and implanted along the opening made by the transverse incision, whilst the left-hand flap (_b_) is turned down and implanted on the oblique raw surface (_c_). It will then be easy to approximate the surfaces _d_ and _e_ together as indicated in the figured diagrams. I have not practised this identical operation as described above, because of the objection there is to the left-hand flap, which contains skin at its upper part, being introduced into the red margin of the lip. [Illustration: FIG. 50.—Giraldés’ or the mortise operation.]