By whatever method the median tubercle has been replaced, it is always advisable to operate at the same time on the soft parts, as the united lip is the best splint for steadying the bone in its new position and giving it as good a chance as possible for becoming fixed. To assist this fixation various plans have been adopted, but with very partial success, _e. g._ the lateral aspects of the cleft and the os incisivum have been freely pared in order to obtain firm adhesions of the raw surfaces, and even silver wires have been passed, a proceeding somewhat detrimental to the developing teeth. Langenbeck,[84] after paring the edges of the prominent tubercle and of the maxilla, transfixed the parts with a harelip pin after replacement into position, and I have myself tried the same plan, but with indifferent success. In discussing the relative merits of these two forms of treatment, extirpation or reposition, it must be remembered that the latter is practically impossible in adults or in patients rather older than the usual infants operated on, for the os incisivum will in such be larger and more bulky than usual, and the palatine cleft having become narrower, the space into which the bone has to be repressed is much smaller than usual. The advantages claimed for reposition are the following: 1. The profile view of the face is much improved by retaining the normal shape of the alveolar border, and the appearance, especially when the mouth is open, as in laughing or yawning, is more pleasant. 2. The normal contour and size of the upper jaw is maintained, preventing the patient from becoming so obviously “underhung” as is commonly the case after extirpation. 3. The patient retains his own teeth, and is able to use them better than any artificial appliances. But such advantages are more theoretical than practical, as the following facts will show. The os incisivum in its new position is admittedly never very firm, and usually has considerable mobility, and hence its use in bearing the incisors is considerably discounted. Moreover the position of these teeth is such that they are both useless and unornamental; for from the rotary movement by means of which reposition is effected, the teeth will generally erupt obliquely backwards; they are in addition often small and decayed. Although it may be desirable to maintain the normal contour of the jaw, we must assert that the presence of the incisive bone between the anterior portions of the maxillæ is by no means an unmixed good, as its wedge-like action interferes materially with the subsequent narrowing of the palatine cleft, and so renders the later operation for the cure of this defect more serious and difficult.