. Operative surgery, for students and practitioners . absent, as already mentioned. Cleft Palate.—The presence of a longitudinal fissure which mayinvolve the hard or soft palate or both. It is caused by a failureof the palatal processes of the superior maxillary processes to meet CONGENITAL DEFORMITIES OF THE FACE. 99 in the middle line and coalesce. In these cases the base of theskull may be unusually broad and the pterygoid processes unusuallyfar apart. Cleft of the Hard Palate.—This may be unilateral or one-sided, the palatal process of the normal side is seen to beunited with the
. Operative surgery, for students and practitioners . absent, as already mentioned. Cleft Palate.—The presence of a longitudinal fissure which mayinvolve the hard or soft palate or both. It is caused by a failureof the palatal processes of the superior maxillary processes to meet CONGENITAL DEFORMITIES OF THE FACE. 99 in the middle line and coalesce. In these cases the base of theskull may be unusually broad and the pterygoid processes unusuallyfar apart. Cleft of the Hard Palate.—This may be unilateral or one-sided, the palatal process of the normal side is seen to beunited with the lower border of the vomer, shutting off that sideof the nasal cavity from the mouth, while upon the affected sidethe palatal process is deficient and falls short of meeting its fellowof the opposite side, and there is thus left an opening which leadsinto the corresponding half of the nasal cavity. In double cleftpalate both palatal processes are deficient, and the lower free edgeof the vomer may be seen between the separated edges of the Fig. 34.—Double Cleft Palate with Advanced Intermaxillary Portion (IM)Carrying the Sockets of Two Incisor Teeth. V, vomer (septum of thenose). Usually the lower border of the vomer does not reach low enoughto present itself in the fissure between the edges of the cleft, andthe cleft thus has the appearance of a median cleft when it is, inreality, a bilateral, or double, cleft. At times we may find the palatal processes of either side prop-erly united with each other, but the vomer fails to grow down suffi-ciently far to articulate with them, and there is thus left a spacebelow the lower border of the vomer through which the two sides ofthe nasal cavity communicate with each other. It should be remem-bered that the vomer does not play any part in the formation of thehard palate. Cleft of the hard palate ends anteriorly, either at the anterior 100 HEAD AND FACE. palatine foramen, which marks the point of junction between theinterma
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