Mr. Davies-Colley has recently published[95] an account of an operation for which, indeed, he does not claim superiority over the usual method of closing ordinary clefts in the hard and soft palate, but which, he urges, should be adopted in the following contingencies—(1) for infants, (2) when the ordinary operation has failed, and (3) when the cleft in the hard palate is very wide. It consists in dissecting up a triangular muco-periosteal flap from one side of the cleft and entirely detaching it anteriorly, its base being at the junction of the hard and soft palate. On the other side a raw surface is prepared for its reception by reflecting a longitudinal flap of muco-periosteum in such a way that it can be turned as on a hinge into the cleft, and maintained in position there. The loose flap is then planted on it, and fixed by sutures. A bridge is thus formed across the hard palate consisting of a double muco-periosteal flap. The advantages claimed for this operation are less hæmorrhage, double thickness of flap, no loss of tissue, absence of tension, and that upward pressure of the tongue is more likely to do good than harm, whereas in Langenbeck’s the reverse is the case. There are obvious disadvantages, in particular that the hard palate is alone united, and that a foramen at the front part of the cleft usually remains; and although in Mr. Colley’s hands it may be occasionally successful, it scarcely appears to be one adapted for general use. As to its applicability in the case of infants, it is probably a procedure not devoid of risk, inasmuch as no operation can be safely undertaken in the majority of cases before the age of three years. The reader is referred to p. 101 for my reasons for this. When an operation has failed, it is surely more advisable to attempt closure of the whole cleft by repeating Langenbeck’s method rather than by a proceeding admittedly incomplete at first and requiring further treatment. When the cleft is wide anteriorly, it must be conceded that ordinary uranoplasty is often not sufficient to effect at one operation complete closure, and an anterior opening is not unlikely to persist, a condition, however, which Mr. Colley’s operation in no way prevents. My own practice, under such circumstances, is to obtain union as far forward as possible at the first operation, and to deal subsequently with the fistula by a modification of the same proceeding. When a triangular opening has been left in front, owing to absence or previous removal of the os incisivum with the maxillæ more or less widely separated by a gap which extends anteriorly to the mucous membrane of the lip, it is often impossible to bring the edges of the cleft together however freely the raspatory is used, and many plans have been devised to meet this very definite difficulty.