CLEFT PALATE. 343 



THE MOUTH. 



Cleft Palate. A cleft may involve both the soft and the hard 

 palates, or the soft palate alone. Very rarely, in the congenital 

 form, the hard palate is cleft without the soft. The cleft is 

 practically median until it reaches the spot where the inter- 

 maxillary suture divides laterally into that between the 

 premaxillary bone and the maxilla. It is uncommon to get a 

 complete cleft of the palate unaccompanied by a hare-lip, though 

 it is extremely frequent for a hare-lip to be present without a 

 cleft of the palate. 



The higher the arch of the palate, the easier as a rule is the 

 usual operation for closure, on account of the greater breadth of 

 the muco-periosteal flap that can be separated. The attachment 

 of the velum palati to the ridge on the posterior aspect of the 

 palate bone indicates the necessity for a free division at this spot, 

 so as to allow the two freshened edges of the soft palate to be 

 brought together by sutures without tension. 



THE GUMS AND TEETH. 



An epulis usually has its origin from the lining membrane of 

 the alveolus of a tooth, and although the prominence of the growth 

 appears upon the gum, its pedicle lies hidden within the tooth 

 socket. In the majority of cases it is therefore necessary to 

 remove the tooth, and cut out the epulis together with that part 

 of the socket from which it is growing. 



An alveolar abscess is present when caries of a tooth causes 

 the formation of pus within an alveolus, and a knowledge of 

 the anatomical relations of the part explains many points in the 

 progress of the inflammation and its treatment. Purulent matter 

 will find its exit along the line of least resistance. It most 

 commonly therefore tracks upwards or downwards along the side 

 of the tooth, and elevating the mucous membrane of the gum, 

 forms a typical " gum-boil," which as a rule discharges itself into 

 the cavity of the mouth. 



