This investigation was carried out to evaluate the velopharyngeal closure and the facial growth after the primary push-back operation in which the raw palatal surface was postoperatively left.
Fifty-five 6-years-old children with the cleft palate (41 children with unilateral cleft lips a nd palates; 14 with isolated cleft palates) were operated at the age of about 2 years, in one of the following three types of operation methods:
1. Wardill's method: Nasal mucosa sep a rated from hard palate bone was approximated and sutured.
2. Section of Nasal Mucosa method: Nasal mucosa was divided transver s ely at the posterior border of the bony palate and pushed backward. The raw area was left on the nasal surface of soft palate.
3. Manchester's method: Nasal mucosa separate d from hard plate bone was cut at the hard palate and pushed backward. So, the raw area on the nasal side was left at hard palate. The patients were evaluated by the nasal emission rat i o, lateral cephalometric roentgenograms and study-models of the dental arch. The results were as follows:
1. In 17(94.4%)of 18 cases operated by Manchester's method there was no nasal escape.
2. The push-back ratio of soft palate according to the lateral cephalometric roentgenograms was the best in the cases operated by Manchester's method.
3. The maxillary depth on the palatal plane was within normal limits in all cases.
4. All of the cleft palate cases had the small angle of SNA and the narrowed and shortened dental arch.

View full abstract

In order to elucidate the relationship of facial anomalies and cerebral anomalies, especially to holoprosencephaly, a single isoraperitoneal injection of 0.2mg/kg vincristine was performed in rats during the period from 7th to 14th day of gestation. Fetuses were extracted on the 21st day of gestation for observation, with the result described as follows:
In the vincristine-treated groups, from 9th day and 6 hours to 10th day and 0 hour of gestation, all embryos and fetuses were dead. The mortality of fetus in the treated groups during the period from 8th and 6hours to 9th day and 0 hour of gestation was 28.2%, while various congenital anomalies were observed in 61.4% of survived fetuses in these groups. The mortality of fetus during periods except for those mentioned above was extremely low and no anomaly was observed in survived fetuses.
Congenital anomalies were observed in this experiment mainly consisted of cerebral an omalies such as acephalia, pseudencephalia or encephalocele, microcephalia or trigonocephalia and facial anomalies such as mandibular hypoplasia, naso-maxillary hypoplasia, cleft lip and alveolous, low position of the ear, anophthalmia and microphthalmia. The incidence of anomaly in other regions of the body was extremely low. Among these anomalies, cerebral anomalies were most commonly observed followed by anomalies of the eye, mandiblar hypoplasia, cleft lip and alveolous, low position of the ear and naso-maxillary hypoplasia in this order.
As for cleft lip and alveolous, unilateral cleft wa s predominant, that followed by median clefo lip, but bilateral cleft was less encountered. As combined anomalies with cleft lip and alveopous, anomalies of the eye, pseudencephalia or encephalocele were most frequently observed and followed by microcephalia or trignocephalia. The incidence of combined anomalies was most frequently observed in unilateral cleft and next in median cleft. The incidence of that was more common in incomplete cleft than in complete cleft. However, the incidence of combined anomalies with complete median cleft was highest. Low position of the ear was noted in 68.2% of fetuses with mandibular hypoplasia, while 40.0% of fetuses with mandibular hypoplasia simultaneously showed low position of the ear, microcephalia or trigonocephalia. As combined anomalies with mandibular hypoplasia, cerebral anomalies were most common, followed by anomalies of the eye.
The differentiation of telencephalon in holoprosencephaly was not observed in s ome but slighty observed in others. No differentiation and incomplete development of arhinencephalia were observed in holoprosencephaly. Such holoprosencephaly were frequently observed in microcephalia or trigonocephalia, and otocephalia. The eye tissues with some incomplete development markedly closed as compared to those in normal fetuses. Fetuses with otocephalia simultaneously showing low position of the ear and mandibular aplasia or hypoplasia had incompletey developed rhinencephalon in general.

View full abstract

Both deviations of the nasal cartilage and premaxilla in infants with the cleft lip and palate have been thought to be factors affecting nasal deformity.
The purpose of this paper is to clarify the relationship between nasal deformity and deviation of the maxilla in 50 infants with complete unilateral cleft lips and palates, before cheiloplasty.
The rotation of the premaxilla causes not only nasal tip and columella deviation b ut also the alar base which deviates the normal side.
The width of the alveolar cleft caused by bone defect, maldevelopment of the small segment, and rotation of the premaxilla correlates with nasal deformity.
Dorsoventral deviation of the nasal alar bas e correlates with the difference of the position between large and small segments, especially due to the poor-developed small segment.
The length difference of the nostril floor on both sides, which causes the sever e nasal deformity, correlates with the width of the alveolar cleft and rotation of premaxilla.

View full abstract

This study was intended to clarify the contraction properties of the levator veli palatini muscle at the condition of the reflex. Eleven adult dogs were used as the experimental animals under an intra-peritoneum anesthesia of the pentobarbital sodium. The tension and EMG activities of the levator veli palatini muscle were recorded simultaneously when the reflex responses elicited by an electrical stimulation to the afferent fibers of the pharyngeal branches of glossopharyngeal nerve (Ph-of/IX).
The results were summarized as follows:
1. The contraction time and half relaxation time of maximal isometric twitch of the muscle were calculated as 45+2.6 msec and 35+1.6 msec, respectively.
2. A summation of the muscle contraction was obtained with 10 frs of repetitive pulse stimulation of Ph-af/IX and the evoked responses was attenuated at stimulus frequen c ies of 100 frs. No swallowing reflex was observed even when the stimuli were giv e n ranging from 1 to 300 frs.
3. The latencies of isometric twitch tension and EMG activities were 19+1.8 msec and 12+1.6 msec, respectively.
4. A time of maximal amplitude of EMG activities was observed at 50+ 2.8 msec after an electrical stimulation, preceding to the maximal isometric twitch tension.

View full abstract

The purpose of this paper was to investigate physical development and growth pattern of cleft lip and / or palate (CLP) children.
The subjects were 84 c left lip and / or palate patients (45 boys and 39 girls) under the care of the Cleft Palate Team of Tohoku University, Dental Hospital.
The height of patients was measured at 6 mont h intervals and hand and wrist roentogenographs were taken at 1 or 2 year intervals for more than 6 years. (ranging from 6 to 15 years)
Height, skeletal maturity and period of beginning of menarche of CLP children were compared with normal children.
1. The height and growth pattern of CLP children were almost same as the average of Japanese normal children from 6 months to 14 years. The maximum (greatest) puberal growth o ccurred at 13 year in CLP boys and at 11 year in CLP girls.
2. No difference between chronological age and skeletal age of CLP children was found with Sugiura's method.
3. The menarche of CLP girls occurred at the mean age 12 years and 10 months.
4. It is suggested by these results that physical development and growth pattern were not djfferent between CLP children and normal children.

View full abstract

One case of van der Woude syndrome and three cases of familial occured conical elevation (C. E. ) were presented. Furthermore, in our clinic we investigated the incidence of C. E. in 40 patints with a postoperative isolated cleft palate (ICP) and examined the incidence of hypodontia regarding the C. E. cases. Four hundreds and six non cleft children were examined as control.
1. A case of van der Woude syndrome: A six-year old girl had a single C. E., unilateral congenital lower lip sinus and complete unilateral cleft lip and palate.
2. The familial occured C. E. cases: case 2 (propositus), one-year old i nfant male, C. E. with ICP. case 3 (elder sister), four-year old girl, C. E. with submuc o us cleft palate (SMCP). case 4 (cousin), three-year old boy, C. E. with SMCP. Mothers of case 2,3 and case 4 had C. E. respec tively. In case 3, SMCP was discovered while being examined for C. E..
3. Family history of the three C. E. patients indicated the autosomal dominant inheritance.
4. Fifteen out of fourty patients (37.0%) had a clinically distinct C. E.. In these 15 patints, hypodontia was recognized in 72.7& of the cases.
5. In 406 non cleft children, only 2 children (0.49%) had a distinct C. E..
6. It was suggested that C. E. was helpful for an earlier diagnosis of SMCP that tended to be difficult to establish.

View full abstract

A statistical investigation was carried out on 729 patients with cleft lip and/or palate who had undergone plastic surgery at Sapporo Medical College Department of Oral Surgery during a n 8year period, from 1976 to 1984. The results were follows.
1.0f all 1932 cases who had undergone the surgical op eration in our clinic, surgery of cleft lip and palate were performed in 729 cases (42.1%).
2. In geographical distribution,337 out of 729 patients were seen in the Sapporo area.
3. Mother's age at the time of delivery ranged from 19 to 44 years old, and the peak was 25 to 29 years old.
4. The rate of performing natural abortion before proband's birth was seen in 12.6% of the cases and artificial abortion was observed in 9.6% of the cases.
5. The rate of predisposed familial occurence was found in 33 out of 500 families(6.6%),13 cases of familial occurence had a history of isolated cleft palate.
6. Associated congenital anomalies were seen in 19.4% of the cases, of which ankylo-glossia was often observed.
7. Primary labioplasty had been carried out with the triangular or modified triangular flap method.
8. Primary palatoplasty by supraperiosteal mucosal flap method has been adopted since 1980, to minimize surgical intervention. The mucoperiosteal flap method had been used till 1980.

View full abstract

A clinico-statistical investigation was carried out on 28 twin pairs with cleft lip and/or plate(CL(P) and isolated cleft plate (CP) visited the First Department of Oral Surgery, Faculty of Dentistry, Tokyo Medical and Dental University from 1966 to 1985. Four pairs of different sexed pairs were dizygous(DZ). In 15 of the remaining 24 same sexed pairs, zygosity assignments were made from immunological and biochemical analyses. Thirteen pairs were given monozygotic(MZ)status and 2 pairs DZ status.
The following resul t s emerge from our data: 1) of 13 MZ twins,4 of 9 were concordant for CL(P),3 of 4 were concordant for CP.2) Of 6 DZ twins, only one was concordant for CL(P), remaining 5pairs were discordant for CL(P).
A total of 77 twin pairs with clefts have been reported from 1941 to 1985 in Japan. In 33 of 77twin pairs, estimates of zygosity were determined from immunological and biochemical analyses. Twenty-two pairs were MZ and 11 pairs were DZ. Using the pairwise method for concordance rate calculation, concordance rates for CL(P) twins were: MZ = 56.3 percent; DZ=10.0 percent. For CP, MZ = 66.7 percent; DZ=0 percent.
Of our 11 concordant t win pairs,7 pairs showed different severity of clefts.

View full abstract

[in Japanese]

View full abstract