The topic of cleft palate speech in Japan is reviewed by examining the literature. Focusing particularly on “palatalized misarticulation,” which is a specific articulatory error that becomes habitual and requires training even after good velopharyngeal closure has been achieved by palatoplasty around the age of one, organic factors contributing to this misarticulation are discussed based on the literature. The significance of sharing valuable research findings on cleft palatal speech widely across phonological systems is also discussed.

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Objective: In patients with unilateral cleft lip and palate （UCLP）, surgical interventions for palatal reconstruction and postoperative scar contraction can lead to narrowing of the maxillary dental arch width and maxillary hypoplasia, resulting in skeletal Class Ⅲ. As a result, maxillary protraction appliances （MPA） are often utilized during the first phase of treatment. However, while there are reports on the short-term effects of MPA, limited information is available regarding their long-term effects. In this study, we conducted a comparative analysis of the long-term effects of MPA in patients with UCLP who had undergone an one-stage palatoplasty. We utilized cephalometric analyses at the initiation of MPA treatment （T0）, at the completion of MPA treatment （T1）, and at the time of full eruption of permanent dentition （T2）.
Methods: We studied patients with UCLP who visited the Tokyo Dental College Chiba Dental Medical Center Or­tho­don­tics between January 1981 and February 2020, showed McNamara line to Point A ≤ 0mm and negative overjet at the initial visit, and diagnosed as skeletal Class Ⅲ due to maxillary inferior growth. A retrospective cohort study and a comparative analysis were conducted using lateral cephalometric radiographs taken before the initiation of MPA treatment, after the completion of MPA treatment, and upon full eruption of permanent dentition. The control group consisted of patients with skeletal Class Ⅲ due to maxillary hypoplasia, without UCLP, who had used MPA for at least one year during the first phase of treatment.
Results: In the skeletal component of the UCLP group, in terms of parameters, the McNamara line to point A showed a significant decrease when comparing the values of T1 and T2. The SNB angle showed a significant increase when comparing the values of T1 and T2, as well as T0 and T2. Both the ANB angle for T1 and T2, and the convexity for T1 and T2, as well as T0 and T2, showed significant decreases, resulting in deterioration of the jaw relationship.
Conclusion: In patients with UCLP, the use of MPA can lead to an increase of overjet, but the effect on anterior growth of the maxilla is limited. Long-term observations have suggested that there may not be a significant improvement in maxillary hypoplasia and skeletal Class Ⅲ.

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Background: Palatalized misarticulation （PM） can occur with a variety of tongue-palate contact patterns in the speech of children with repaired cleft palate. In order to assess the degree of placement deviation by perceptual evaluation, a novel “backing score” for PM was developed.
Objective: To investigate the perceptual reliability and classification of the novel “backing score” for PM.
Design: Prospective study of perceptual judgments of speech using multiple listener ratings of articulation.
Outcome Measures: Four participants （2 listeners specializing in phonetics and 2 speech therapists） rated 55 audio-recorded Japanese speech samples containing PM, produced by children with repaired cleft palate. Listeners transcribed two backing scoring patterns, with/without a retracting mark （-）, for five mono-syllabic VCV speech samples, ［asa］, ［ata］, ［oto］, ［utsu］ and ［iɕi］, using the International Phonetic Alphabet （IPA）. One week later, perceptual judgement was repeated to assess intra-rater reliability. Inter-rater reliability was also computed.
Results: Higher intra- and inter-rater reliability was observed when coding backing errors without retracting marks. Reliability was the highest for the plosive VCV ［oto］, and the lowest for the fricative VCV ［iɕi］. Also, regarding articulation placement for PM, three sites were perceived: soft-palatalized, palatalized and post-alveolar.
Conclusion: Deriving a backing score without retracting marks may be a useful tool to subclassify PM errors. However, there are limits to the accuracy of perceptual judgments of backing, especially for fricatives. Future studies should consider including audio-visual stimuli, such as electropalatography （EPG）, to determine if this facilitates improved rater accuracy and reliability of error coding. Transcription findings suggested that PM may be subdivided into post-alveolar, palatalized and soft-palatalized place of articulation.

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In many patients, cleft lip and palate is often accompanied by narrowing of the maxillary arch and congenitally missing lateral incisors; therefore, early orthodontic treatment is required through a team approach by specialists. For alveolar clefts, iliac cancellous bone grafting is performed for canine eruption. However, if the width of the alveolar cleft is wide, the formation of a bone bridge may fail due to the poor stability of the grafting. In recent years, a method called Interdental Distraction Osteogenesis （IDO）, which applies the concept of bone transport, has been reported to reduce the width of the alveolar cleft. We report here a successful case where IDO was performed on a patient with a wide alveolar cleft for maxillary alveolar movement and orthodontic treatment.

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