As with harelip, so with cleft palate, the extent of the defect varies greatly in different cases. Thus in the most severe forms, there is a total mesial longitudinal cleft, extending forwards from the tip of the uvula to the level of the anterior palatine canal, thence bifurcating to communicate anteriorly with a double alveolar harelip, the os incisivum or central portions of the intermaxilla being usually displaced forward (Fig. 9). Such a condition is known by German authors as “Wolfsrachen,” or wolf-jaw. The vomer descends in the median line usually into close quarters with, but separate from the margins of the cleft, and the os incisivum is attached to its anterior extremity. When the vomer comes far down and is well developed and prominent, and the palatal outgrowths small, the cleft appears to be double, but is not so in reality (Figs. 9 and 10). [Illustration: FIG. 9. FIG. 9.—Complete cleft palate and double alveolar harelip; simulating a double lateral cleft, due to the vomer being seen free between the palatal segments. (_Mason._)] [Illustration: FIG. 10. FIG. 10.—Complete cleft palate without alveolar or labial deformity; the vomer is separate from the lateral segments. (_Mason._)] [Illustration: FIG. 11.—Complete unilateral cleft palate without alveolar deficiency; the vomer is attached to the left palatal segment. (_Mason._) FIGS. 12, 13, 14.—Various degrees of simple fissure of the palate. (_Mason._)] Not unfrequently the vomer is attached to one of the margins of the cleft, this condition being usually associated with unilateral alveolar harelip. Such attachment always occurs on the side opposite to the fissure in the alveolus; that is to say, since unilateral harelip is more common on the left, the vomer is usually attached to the right side of the cleft. Fig. 11 indicates the less common condition of attachment of the vomer to the left palatal segment. Rouge[2] and Oakley Coles[3] fully confirm this statement. The cleft may, however, merely implicate the soft and hard palate, leaving the alveolus and lip perfect, and does not then extend further forward than the site of the anterior palatine canal, and is strictly median (Fig. 12); or it may be still more limited, involving more or less of the velum, perhaps only the uvula, or extending a variable distance into the hard palate (Figs. 13 and 14). [Illustration: FIG. 15.—Unusual form of cleft involving the alveolar arch, and the anterior portion of the palate only. (_Mason._)]