Nasopharyngeal fiberscope (NPF) coupled with video recording system was utilized to analyze the timing of velopharyngeal movement during speech. The timing of velopharyngeal closure (TC)and timing of maximum velopharyngeal movement (TM) were determined based on the time of speaking or articulatory release. The participants were 20 normal subjects speaking Kansai dialect Japanese and 20 patients with spatial velopharyngeal incompetence. A superior based pharyngeal flap operation (Unified velopharyngeal plasty) as given to the 20 patients by one surgeon, and differences of velopharyngeal movement timing among pre and post surgical conditions in those patients were also investigated.
The present stu d y indicated the following results.
1. The normal subjects demonstrated that the closure and maximum movement of the velopharynx were provided with programmed timing which was appropriate to the sound produ c ed.
2. The twenty patients with VPI presurgically showed several types of temporal controls of the velopharyngeal movement different from the timing of the normals. TC was not measure d because of lack of complete closure. The patients were grouped into three categories b ased on TM measurement. Group A (6 patients) showed statistically similar TM of vowels to those o f the normals and indicated the temporal difference of TM between vowels and consonant /P/. Group B (4 patients) showed only statistical coincidence of vowel TM with those of the normals. Group C (10 patients) showed no statistical similarity of temporal control of velopharyngeal movement with those of the normals.
3. The ten patients categorized i nto Group A and B with similar vowel TM to those of the normals showed remarkable improvement of the velopharyngeal closure in both timing and spatial closing mechanism. The post-surgical measurement of TC statistically coincided with th o se of the normals. Intelligibility of the sound also improved. To the contrary, the patients categorized into Group C showed no improvement of temporal control of the velopharyngeal c losure nor sound intelligibility, though several patients achieved complete velopharyngeal closure after t he pharyngeal flap surgery.
4. The present data indicated that the knowledge concerning the vowel TM provided prognostic evaluation of velopharyngeal incompetence for pharyngeal flap surgery.

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The respective degree of the intrinsic and surgical effect of the cleft lip and/or palate on the craniofacial growth of the patients was investigated by analysis of logitudinal roentgencephalograms taken from 123 cleft patients at the cheiloplasty, palatoplasty and the age of four. The data were compared among the groups classified by the site and degree of the cleft, and at the age four, compared with the data of non-cleft children to examine the transition of the craniofacial shape.
Preoperatively, each cleft type had a characteristic feature of the craniofacial shape depending on the site and degree of the cleft, and this trends were found to persist longitudinally at the age four.
Thus, both before and after surgery, the group of cleft lip with or without cleft palate showed the superior position of the anterior palatal plane, the wider interorbital breadth and the lingual inclination of the upper deciduous teeth. Added to the above trends, the posterior palatal plane was more superior in the group of cleft lip with cleft palate. In comparison with noncleft children and the group of cleft lip with or without cleft palate, the group of cleft palate only showed the retardation in the forward growth of the cranial to maxillary region, but there was no retardation of downward growth. In general, the group of wider cleft showed higher degree of retardation in the forward and downward growth of the maxillary region. These trends were neither decreased nor increased after surgery.
However, the wider upper dental arch breadth accompanied with the cleft of alveolus and/or palate diminished at an age of four.
These result seem to indicate that the retardation of the craniofacial growth is mainly affected by intrinsic factors of the cleft lip and/or palate anomalies and the conservative cheiloplastic and/or palatoplastic operation have little effect on it.

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Velopharyngeal function and articulation following primary palatoplasties were investigated in 243cleft palate subjects. Operations based on the palatal push back method were performed on the patients from 1977 to 1981. The 243 subjects included 41 patients with bilateral cleft lip and palate,44 with unilateral cleft lip and palate,31 with soft and hard cleft palate and 58 soft palate.
The operation were performed between the ages of 11 months and 52 years,89 % were u nder 2years of age. The evaluation was undertaken before speech training and secondary operation. Velopharyngeal function was evaluated by oral survey, speech (vocal resonance and production of pressure consonants), soft blowing, lateral view radiography and nasopharyngeal fiberscope inspection.
The results were as follows:
(1) About eighty-nine pe rcent of the subjects showed good velopharyngeal closure.
(2) The incidence of subjects with good velopharyngeal closure was high in unilateral cleft lip and palate and soft cleft palate, and also in the groupe of youngest age.
(3) Forty-four percent showed normal speech.
(4) Incidence of articulation disorders w as fifty-one percent.
(5) There was a trend toward higher percentage o f patients with articulation disorder as the severity of the cleft increased and the age of operation was older.
(6) Palatalized articulation was the highest in frequency, the second lateral articulation and the third was glottal stop.

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For the purpose of establishment of proper orthodontic management on each cleft type, in the present study, dentoskeletal morphological analyses were taken of 41 cleft lip cases (33 unilateral,8bilateral) and their orthodontic treatment planning was surveyed from the files of Orthodontic Clinic of Tokyo Medical and Dental University.
As the result of investigati o n, a high incidence of rotation on upper central incisors was observed. The percentage of micro shape or congenital missing on upper lateral incisors was high.
Compared with non-cleft cephalometric data, patients with cleft lip showed lingual tipping of upper incisors, but no other difference besides the forward position of maxilla in bilateral cleft lip.
Orthodontic treatment for these cases, used in this study, had been carried out mainly with the labial movement of upper anteriors and alignment of the individual tooth. Chin cap and extra oral anchorage for the growth control of mandible or maxilla were used in limited cases.

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It is widely known that patients with repaired clefts generally show severe malocclusions. Although the presence of masticatory dysfunction is suspected, little information is available about the reality of the dysfunction in daily life. An attempt was made to investigate what is the masticatory dysfunction in the patients with repaired clefts by means of questionnaire.
Questionnaires were collected from 119 patients who visited the Orthodontic Cl i n ic, Osaka University Dental Hospital. As control,29 adult subjects with good occlusion were used.
According to the types of cleft, patients consisted of UCLP (55%), BCLP (28%) and C L and CP (17%) respectively. On an average, primary lip repair was performed at 5 months old and secondary repair was conducted at 5 years and 3 months old. Primary palatal repair was performed with mean age of 2years old.
Height and weight of the patients were not so different from the normal value of Japanese, but were slightly smaller.
Caries inci d ence was similar to that of control group. Cross-bite was seen in 65-85% of total cleft group in the anterior and posterior segments. Crowding was most frequently s e en in the anterior segment especially in the upper jaw. The results were as follows:
1) On the disorder of digestive s ystem the incidence of stomachache and diarrhea was higher than the control group.
2) The cleft gro up showed a tendency to eat less and take longer to do so than the control group.

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A survey on the incidence of cleft lip and/or palate has been conducted on the 1009 hospitals which were located in major 15 Prefectures of Japan. Out of the 384,230 birth records,701 infants with cleft lip and/or palate were identified. The incidence of all cleft types in Japanese is calculated to be 0.182 per hundred live and still births, with the following incidences for each cleft type; cleft lip 0.052, cleft lip and palate 0.086, and cleft palate 0.037 per hundred live and still births.
The analysis for the geographical variation indicated that the Western part of Japan showed higher incidence of the cleft birth than those of the Eastern area.

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Citation analysis based on the information science is important not only to evaluate the reference but also to know which one or which journal should be retrieved in future. Such analyses, however, have scarecely been reported by medical or dental scientists because of difficulty in getting huge energy to perform the job.
The present study was ai m ed to analyze the references cited in the cleft lip/palate articles. The subjects were 2,905 references appeared in the journals (cited references) which were the majority of 3,294 references cited in the 125 articles published in the J. Jap. Cleft Palate Assoc. of the volumes 1 through 9. The years and the names of the journals in which the references were appeared (cited journals) were analyzed, and were related to the theme of the articles in the J. Jap. Cleft Palate Assoc. (theme).
Some of the results were as follows.
1. Many of the cited references w ere appeared in a few journals. On the contrary, from most of the cited journals only less than five articles were cited. These tendencies were more evident in t h e foreign language references and journals.
2 In most themes J. Jap. Cleft Pala te Assoc., Jap. J. Oral Maxillofac. Surg., Cleft Palate J. and Plast. Reconstr. Surg. were cited frequentry, and in some themes references from journals ot h er than these were also often cited.
3 The numbers of the cited ref erences per one J. Jap. Cleft Palate Assoc. article were large in such themes as jaw development, speech, statistics, complications in the Japanese cited referenc e s, and in jaw development, velopharyngeal function, complications in the foreign langua g e ones,
4. In both Japanese and foreign language ones, the numbers of the cited references per one cited journal were large in such themes as jaw development, velopharyngeal function, speech and orthodontics.
5. Approximately 70% of the Japanese cited references had been published in previous about 5years, but about 60% of the foreign language ones had been in previous about 10 to 15 years.
6. Most of the foreign language cited references were written in English, a few in Germany, an d few in other than these two. The cited references written in other than English were published about ten years prior to the English ones.

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Investigating 94 mother psychological status after delivery of children with cletf lip and palate, we used CMI-Health Questionnaire, and the following results were obtained.
1) The mother's psychological status showed almost the same CMI distrib utions as normals' by putting to use Fukamachi's discrimination.
2) Considering the patients from a sexual viewpoint, girl's mothers tended to show high ratio of stage III and IV.
3) From this in vestigation, we found that the delivery of such children would not influence them to psychosomatosis or neurosis.
4) Analyzing the mental item s, we obtained the result that the mothers were in a irritable, a sensitive condition and were not attached to surroundings.

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[in Japanese]

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[in Japanese]

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