Some surgeons have detached one muco-periosteal flap anteriorly, and so been able to bring it across the cleft and stitch it to the opposite side. But the interference with the vascular supply to the apex of the flap, and the rapid shrinkage which is apt to take place, frequently make matters worse than before. My experience of this plan has not been satisfactory. Another method that I have recently employed with partial success consisted in reflecting a flap of mucous membrane from the back of the upper lip, and turning it down into the gap, fixing it laterally to the refreshed margins by fine wire sutures. Even if complete union does not take place, the portion thus reflected forms a _point d’appui_ for later plastic interference. It has also occurred to me to try the effect of cutting through the alveolar process immediately external to the canine tooth; that is, instead of detaching the palatal flap anteriorly to continue the lateral incision forward through the bony alveolus and after partially detaching this to prise it towards the median line. This proceeding is practically a modification of Fergusson’s osteoplasty, but differs from it inasmuch as there is little fear of necrosis on account of the spongy and vascular state of the alveolus. In the performance of it, after the palatal flaps have been detached by the raspatory, I incise the gum vertically along the line indicated, that is, continuing the lateral incision forward external to the canine tooth; a notch is then made with a small saw, and a chisel inserted cuts through and sufficiently detaches the portion of the alveolar process contiguous to the palate. The edges are now carefully freshened, and, if necessary, on the bevel, so as to allow for the slight rotation which occurs in drawing them together. Sutures are passed through the soft tissues deep enough to gain a firm hold of the flaps, so that when twisted they do not cut their way out in spite of the traction which is exercised. Care must be taken to pass the stitches in such a manner as to prevent undue rotation of the detached portions, otherwise the raw edges will not come into proper contact. Having at present given this plan but a limited trial, I do not wish to speak too confidently in its favour. Should such operative proceedings fail, an obturator should be fitted to the aperture.