The conditions which are essential to a complete success after plastic operations for cleft palate are as follows: complete closure of the cleft with no fistulous communication in any part of the line of union, and a velum capable, when necessary, of being approximated to the posterior pharyngeal wall so as to shut off the nasal cavity during speech and deglutition. That this is not invariably attained is an undoubted fact, and in spite of the merest shaving being removed when paring the edges of the cleft, the velum when united is frequently so scanty as to be unable to fulfil this condition. To remedy this, it was proposed some years ago by the late Mr. Mason to loosen the soft palate by lateral incisions, passing downwards and backwards through the free border, thus relaxing the tension, and allowing it to be drawn upwards, when requisite, into relation with the pharyngeal wall. I have adopted this plan in several cases, but with only transient success, inasmuch as the subsequent cicatrisation of the incisions neutralises the temporary benefit derived. The division of the pillars of the fauces, however, is occasionally needful and more satisfactory. This has been already alluded to (p. 127), and may either be performed at the time of the first operation, or subsequently if found to be necessary. Even in cases where the tissue is abundant, and the united velum loose and moveable, the immediate effect on the speech is not always satisfactory. The other advantages of the operation (_e. g._ exclusion of nasal mucus from the mouth, prevention of regurgitation of fluids through the nose, improvement in taste and smell, and the psychical effects) are immediately apparent; but speech is a more complicated proceeding, and the first result of the operation is often to dislocate the mechanism which the patient had formerly made use of in its production, and hence, as has been often noticed, speech and voice may be temporarily deteriorated, even after a successful operation. This is a disappointment both to the patient and friends unless they have been previously warned. A subsequent thorough educational course at the hands of a professional voice-trainer, if possible, is therefore most important.