The treatment of the os incisivum has given rise to considerable discussion, and the practice of various surgeons differs greatly. Whilst some, especially on the Continent, have advocated its retention, others, particularly of the English school, have just as strongly urged its extirpation. One thing is plain; if the bone is to be retained steps must be taken to restore it to a normal position. It will be well to describe _seriatim_ the different plans of treatment which have been suggested, and subsequently to discuss their relative value. The oldest and simplest method consists in the complete removal of the bone, or, as it is sometimes called, the operation of Franco.[79] This should be always undertaken as a preliminary step a week or two prior to dealing with the soft parts, and is effected in the following manner:—The central portion of the upper lip, together with all the available tissue which can be turned up, is first dissected away from the bone and left attached to the columna nasi. The mucous membrane behind the projection is then incised transversely to allow of the introduction of a pair of cutting pliers, by which the separation of the bone from the vomer is effected. Smart bleeding from the anterior palatine vessels frequently occurs, and may require a touch of the cautery to stay it. No after-treatment is necessary, as the stump rapidly cicatrises. The child should be well fed up in view of the subsequent operation upon the soft parts. Where the os incisivum is retained, the following methods for its treatment have been adopted: 1. Gradual and continuous backward pressure by means of a bandage (Desault). In this plan the bandage requires constant attention to keep it sufficiently tight; and it is very doubtful whether much effect can be thus produced, especially when only applied, as in Desault’s cases, for from ten to eighteen days. The use of elastic tension by means of india-rubber has been also recommended (Thiersch). The effect of such treatment will be to bend the vomer in proportion to the amount of repression; but much pain must always be produced by this process, and the vitality of the central part of the upper lip may be seriously impaired. It would appear from Desault’s writings that he only advised this proceeding in cases where the projection of the bone was slight, and where there was a certain amount of mobility owing to the median septum being soft and cartilaginous, conditions which do not often obtain; and certainly statistics do not show any large number of cases treated. Where, however, the projection is but slight, and the vomer not too strong and hypertrophied, this plan deserves a trial prior to undertaking more serious steps.