Using the cineradiographic study, the characteristics of the deglutition pattern and the coordinated function of oral structures were evaluated for post-operative cleft palates. Nineteen patients (10 males and 9 females) were provided and 17 normals (15 males and 2 females) were selected as a control group. The clefts were divided into 2 groups (good and poor) according to the velopharyngeal competency. The movements of oral structures were analyzed quantitatively frame by frame, and the time points which were physiologically significant during the deglutition were set up. The tongue's function was evaluated by the tongue depression rate and the patterns of the hyoid bone movement. In the cleft palate groups, oral weakness and/or hesitation of swallowing were observed. The poor group showed significantly more overall time of deglutition than the normal group. The time relationship between velopharyngeal closure (VPC) and tongue depression (TD) was one of the most specific features. In the normal group, VPC occurred definitely earlier than TD, but in the poor group, it was delayed, to a large extent. In the good group, the delay was rather small. The tongue depression rates in the cleft palates were larger than those of the normal group. The poor group showed the largest rate which seemed to be compensatory efforts of velopharyngeal incompetency. The patterns of the hyoid bone movements were also different among the three groups corresponding to their tongue function. The results suggested that the abnormal pattern of tongue movements might depend on the velopharyngeal incompetency, and there was a loss of coordinated function between the VPC and TD during the deglutition caused by the malfunction of the velopharyngeal closure.

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The normal surface anatomy of the lip and nose is very important for cleft lip surgery. The face of 501nomal Japanese children from ages 3 to 6 were measured on the pictures taken from the same distance on Median and Frankfort Plane using a head fixation and photo apparatus.
1) The measurements at the age of 3 were as follows. Nasal width was 29.0 mm±2.0, columella width 6.4 mm± 0.7, width of nostril flower 6.7 mm± 0.8.
2) Medial vertical height of the lip was 13.7 mm± 2.1, vertical height from base of columella to cupid's bow peak 13.4 mm± 1.8, vertical height from nasal ala base to cupid's bow peak 13.0 mm± 1.6, vertical hei g h t from nasal ala base to commissure 20.9 mm± 2.4, width from commissure to commissure 33.2 mm ± 1.8, width from cupid's bow to commissure 14.4 mm± 1.7, width from cupid's bow to cupid's bow 8.3 mm ±1.6, angle of the cupid's bows 145.8°± 4.3.
3) Medial vertical height of the upper vermilion was 5.1 mm± 1.3, vertical height of the upper vermilion of the cupid's bow 5.6 mm± 1.3, medial vertical height of the lower vermilion 7.3 mm± 1.7.
4) Those measurements varied among individuals and no significance was observed in either sex or side.
5) The growth between the ages of 3 to 6 was not so rapid as to be more than individual differences.

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The study was intended to clarify the contract i o n properties of the levator veli palatini muscle in reflex deglutition. Twenty-four adult dogs (8-13 kg) were used under an intra-peritoneum anesthesia of the thiopental. The tension and EMG activities of the lavator veli palatini muscle were recorded simultaneously during the reflex deglutition elicited by an electrical stimulation to the superior laryngeal nerve (SLN).
Results were as follows:
1. In the reflex elicited by a single pulse stimulation to the SLN, the contraction time and half relaxation time of maximal isometric contraction curve of the levator veli palatini muscle were 45± 3.1 m sec. and 32± 1.8 msec. respectivily, and latencies of the EMG activities and isometric contraction curve were 2 0 ±1.2 msec and 27 ± 1.9 msec. respectivily.
2. Deglutition occurred with more than 10 frs repetitive pulse stimulation of afferent fibers of contralateral SLN.30 frs in stimulation frequencies were optimal to cause deglutition.
3. The average duration of EMG activities in the levator veli palatini muscle during reflex deglutition was 397± 50 msec. EMG activities in the pterygopharyngeus muscle appeared simultaneously with that in the levator veli palatini muscle, and the EMG activities in the mylohyoideus muscle was delayed after that in the levator veli palatini muscle by 40 msec. and that in the venter anterior digastricus muscle was delayed after by 110 msec.
4. The tension of levator veli palatoni muscle in the reflex deglutition reached the maximum at 89±6.7msec. from onset of contraction, and evoked tension attenuated at 187± 19 msec.

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There are many kinds of congenital malformations associated with cleft lips and palates.
Malformation of the eye, especially in cases associated with microphthalmia or anoph t halmia is rare all over the world.
A five month old child with syndromic occurrence of multiple malformations such as a bilateral cleft lip and palate, anophthalmia of the right eye and accessory ear is presented in this report.
Furthermore, genetic-original investigation is made in this report.
13-trisomy and Meckel syndrome are needed for discrimination in this case.

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Three hundred and thirty cases with cleft palate, operated on, primarily, at our institute from January 1977 to December 1982 were investigated for velopharyngeal function and articulation.
The 330 subjects included 49 children with bilateral cleft lip and palate.144 with unilateral cleft lip and palate and 137 with isolated cleft palate. The operation was performed by push back method of subjects between the ages 16 and 35 months. No systematic training was undertaken postoperatively. Velopharyngeal function was evaluated by means of inspection, blowing and speech.
The Sufficient velopharyngeal function, slight hypernasality and hypernasality were observed in 290cases (87.9 %),21 cases (6.4 %) and 19 cases (5.8 %), respectively.
In view of the cleft types, sufficient velopharynge a l functions were obtained in 130 out of 137 cases (94.9 %) in the isolated cleft palate group, and 160 out of 193 cases (82.9 %) in the cleft lip and palate group.
Articulation disorders were observed in 126 cases of the total 266 cases (47.4 %). Palatalized articulation accounted for 73 cases (27.4 %), lateral articulation 59 cases (22.2 %) and glottal stops in 35 cases (13.2 %).

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It is a laborious and difficult task to close the alveolar cleft in the lip repair of a wide cleft lip and palate.
A technique, using pediculated mucocutaneous flaps raised from both cleft margins of lip, was contrived and applied to 28 patients with unilateral cleft lips and palates.
The method is as follows:
1) After the skin incision, for which the triangular flap method is selected, a mucocutaneous flap,20-25mm in length and 5-7 mm in width, is raised from the medial point of the lateral lip with the base widely attached to the anterior edge of the alveolar ridge.
2) On the lateral aspect of the medial lip (prolabium), another short flaps is prepared in the same manner.
3) The nasal floor is constructed by suturing both margins of reflected mucous membrane on the inner surface of the alanasi and on the anterior part of the nasal septum.
4) The long flap on the lateral segment prepared in step 1 is turned 180 degrees at the middle into a U-shape. The center line of the U is sutured, so that the flap is doubled in width.
5) The medial flap prepared in step 2 is rotated backward at the base, then fixed to the cleft margin of the premaxilla. The opposing edges of the two flaps (the medial of the U flap and the lateral of th e pre-maxillary flap) are sutured. Thus the oral aspect of the alveolar cleft is covered by the mucocutaneous flaps with three lines of sutures.
6) Mattress sutures are placed to approximate the nasal floor and mucocutaneous coverage of the oral side.
Twenty-eight patients have undergone this operation.
No cases showed defects or separation in th e mucocutaneous cover. Eighteen of them have received palatal closure. Sixteen patients were free from oronasal fistulas and only two have developed a small fistula in the anterior palate.

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Although various methods have been advocated for the repair of cleft palates during this century, a palatal push-back method, with reconstruction of the levator muscle is most widely used at present. We have also used this method, and have obtained satisfactory speech results in about 85% of the cases. The rmaining 15% have needed speech therapy and/or reoperation. We found that such cases with poor results often revealed not the long horizontal distance but the long vertical distance of the velopharyngeal space. In order to pull the velum upward at the rest position, instead of pushing it back, we devised a new technique called the Palatal Pull Upward Method. The incisions along the cleft on the palate are further away from the cleft on both sides. An incision of the ridge of the vomer is made to the cranial base. The mucoperiosteal flap of the vomer is elevated only on the left side. The right oral mucosal flap of the palate is turned over and inserted under the left vomer flap. These two flaps are fixed with mattress type sutures. After the left oral mucosa is turned over, and fixed to the left edge of the vomerian flap and the opposite oral mucosa, the levator muscles on each side are sutured together to construct a muscle sling. Varner flaps have been widely used for cleft palate surgery. We, however, bring the velum upward by use of the vomer in the direction of the levator muscle constriction at the rest position, thus reducing the vertical distance of the velopharyngeal space. Therefore, the most important point is that the velum is pulled upward to the cranial base of the vomer. Other important points are that only one side of the vomer is elevated so as not to inhibit growth of the maxilla and mattress type sutures are used for attachment. We have used this method and had satisfactory speech results in all 20 cases.

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Seventy patients with cleft lips and palates were selected after the retention period of the orthodontic treatment in order to investigate postoperative appraisal using the opinionnaire method. Methods for the investigation were as follows. Motives for the orthodontic treatment, appraisals for the facial profile, dentition, and oral function, psychological effects, economic and social problems.
Most of the subjects are satisfied with the better dentitions and o c clusion, and feel happy and gain self-confidence after the orthodontic treatment. On the other hand, some of them are still dissatisfied with the asymmetric shape of the lips and nose, and the articulation.

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In order to promote improved postoperative therapeutic results for patients with labial and palatal clefts, the authors conducted periodical surveys on patients' mothers, who have the closest relationship with the patients, after each stage of therapy by using a free descriptive question-naire method. The objective of the survy series was to see changes in recognition, emotion and action of mothers and other family members toward patients over time. This survey was conducted on a total of 393 mothers of which,104 were mothers of patients with cleft lips,71 were mothers of patients with cleft paiates and 218 were mothers of patients with cleft lips and palates. During a postoperative period, the following conclusions were drawn:
1. Therapeutic treatment greatly reduces the psychological pressure on mothers are family members. This is especially true of cleft lip surgery.
2. Maternal grandparents are supportive of the patients' mothers from the pre-operative time and remain the same after the operation.
3. Paternal sisters who show self-centered and non-supportive attitudes to the patients' mothers in the preoperative time do not change their attitude after the operation.
4. Neighbors' attitudes are relatively indifferent, which suggests that there is a lack of public understanding about this disorder.
5. Although mothers are relieved to a certain degree after the primary plastic surgery, many of them are still concerned with their children's appearance because they fear the surgery did not fully resolve the problem. Many mothers of patients with cleft palates are concerned about speech problems even aft e r the operation, largely because speech improvement is difficult to assess immediately after the operation. Also, a number of mothers are worried about the recovery of oral function as the teeth straigh t en and the jaw grows. Thus, it is important to discuss these postoperative anxieties with the patients'mothers.

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