This study was designed to learn current treatment plans in Japan for lip, alveolus and palate cleft patients by means of questionnaire.
Questionnaires we r e collected from 54 medical institutions belonging to the Japanese Cleft Palate Association. Then treatment plan summaries were compared with the European and American plans of 30teams represented in the 1984 Zurich Symposium.
The results were as follows.
1. Presurgical orthopedics is done mostly routinely in the European and American teams, but only occasionally by the Japanese teams for cases with severe extending premaxilla.
2. Unilaterral cleft lip is closed by a Tennison or Millard procedure in Japan as well as in Europe and America.
3. Cleft palate is closed with push back procedure by most Japanese teams. On the other hand, the European and American teams use various operation methods such as Wardill procedure, von Lange n beck procedure, two-stage mucosal flap method and early veloplasty.
4. Speech monitoring and intensive speech therapy are done routinely in most Japanese teams.
5. The regular ENT monitoring is done in 24 out of 30 teams in Europe and America and only in 12 out of 52 teams in Japan.
6. Orthodontics in deciduous dentition is not done routinely in Europe and America as well an in Japan.
7. Secondary bone grafting is performed routinely in mixed dentition by most of European and American teams, and occasionally in permanent dentition by the Japanese teams.

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In orde r to clarify the cause of inhibition of maxillary growth in the cleft palate, the maxillary growth resection to the midpalatal suture, which has been considered to play an important role in the lateral growth of the palate, was studied histologically in rats.
The animals were randomly divided into group A of untreated control, group B with elevation of the palatal mucoperiosteum, group C with bone resection of the palate except for the midpalatal suture, group D with bone resection including the midpalatal suture.
The results are summarized as follows.
1. The lateral growth of the palate took place exclusively by the additional ossification at the midpalatal suture toward the midline.
2. The amount of additional ossification at the midpalatal suture tended to decrease with age.
3. Although the perichondrium of the maxillary bone at the midpalatal suture was clearly observed at 30 days after birth, it became thinner at 70 days and only a trace was found at 200 days. Both ends of the pala tal bones which were parallel to each other at 30 days after birth became fused with interdigitation at 70 days. The interdigitation became more pronounced with age.
4. In group B, the wound healed promptly, and left no evident adverse effects on the lateral growth of the palate.
5. In group C, the wound healed completely by 40 days after the operation. However, the amount of additional ossification at the midpalatal suture was much less than that of the untreated group.
6. After resection to the midpalatal suture, the flat ends of the palate remained separated by coarse collagen fibers with no tendency to regeneration of the original suture.
7. The results suggest that the midpalatal suture of the rat has roles to buffer the physical force as well as to control the bony growth of the palate.

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In order to clarify the cause of inhibition of maxillary growth in the cleft palate, the maxillary growth after resection to the midpalatal suture was studied quantitatively in rats.
The animals were randomly divided into group A of untreated con t rol, group B with elevation of the palatal mucoperiosteum, group C with bone resection of the palate on except for the midpalatal suture, group D with bone resection including the midpalatal suture. In each group, serial maxillary casts were made for subsequent measurements of the palatal width.
The results are summarized as follows.
1. When compared with the untreated group, the lateral growth of the palate was most severe in group D; which was followed in order of severity by group C and group B.
2. Elevation of the palatal mucoperiosteum had the least effect on the lateral growth of the palate.
3. In group C, the rate of inhibition showed a tendency to decrease 40 days after operation.
4. Resection to the midpalatal suture produced the most prominent and long lasting inhibition of the bilateral growth of the palate.
5. The midpalatal suture defect was found to have a much greater effect on the lateral growth of the palate than the surgical intervention of the palate itself.

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Characteristics of feeding difficulties in infants with cleft lips and palates and the effects of Hotz's resin plate on the improvement of sucking were studied by recording the body weight growth rate, the milk volume sucked per day, the standard feeding time, and the pressure in the nipple during sucking behavior.
The nipple pressure was measured with a newly designed instrument and the negative pressure in the mouth (the sucking pressure) was calculated from the nipple pressure. The infants treated with Hotz's resin plates had a cleft of hard and soft palate (HSCP,2 cases) or a cleft lip and palate (CLP,34 cases), which was incomplete (ICLP), complete (CCLP), unilateral (UCLP), or bilateral (BCLP).
The control group consisted of normal infants (N,10 cases), infan t s with a cleft lip (CL,15 cases), which was incomplete (ICL) or complete (CCL), and those with a cleft of soft palate (SCP,6 cases). The following results were obtained.
1. The CL a nd SCP groups were different from the N group in the distribution of occurrence of nipple pressure wave patterns. The negative nipple and sucking pressure of these groups were lower in magn itude than those of the N group.
2. When the resin plate was removed, the CLP and HSCP groups showed distributions of nipple pressure wave patterns significantly different from those of the N, CL, and SCP groups. The negative and positive pressure as well as the sucking pressure were clearly lower in CLP and HSCP groups than control groups.
3. The decreased suction ability showed a clear correlation with the degree of cleft. In general, th e CCL, CCLP and BCLP groups were lower in the ability than the ICL, ICLP, and UCLP groups, respectivel y.
4. When the resin plate was set, the CLP and HSCP groups showed much improvement of sucking. The distribution of nipple pressure wave patterns, the burst time, and the actual sucking time ratio became c lose to those of the N, CL, and SCP groups. Significant increases were also observed in the sucking rate, the negative and the positive nipple pressures and the sucking pressure.
5. The improvement of sucking was good in the infants (CLP-I group) who had been treated with the resin plate within one month after birth compared to those (CLP-II group) treated later.
6. The body weight growth speed was generally lower in the CL, SCP, CLP, and HSCP groups than in the N group. The CLP-I group was better than the CLP-II group in the growth speed, the milk volume suck ed per day, and the standard feeding time. This observation indicates that the treatment with Hotz's resin plate should be done as soon as possible after birth.

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The purpose of this study is to investigate the effect of age-related factors on muscle regeneration. In this study, the Orbicular oris muscle of rabbit is examined histologically and morphologically to document the recovery after partial excision of the lower lip. The rabbits of 10,30 and 180 days of age (Group B, C and D respectively) were subjected partial excision of lower lip. Lower lip growth was estimated by measuring of thickness and cross-sectional square measure of the lower lip. Muscle regeneration was estimated microscopically, measuring of the muscle fiber diameter and calculating the M/C ratio (muscle/connective tissue ratio).
Results obtain e d were as follows:
1. Muscle regeneration was better in Group B, than the other two groups, suggesting that the immature muscle tissue has higher regeneration ability.
2. The growth of lower lip was restrained in Group B, particularly at the vertical growth of it.
From these, the presence of more influential factors about wound healing and growth of the lower lip is suggested to be considered.

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In the treatment of cleft lip and palate patients, mostly upper anterior prosthetic appliances are needed for obtaining proper lip support and improving the facial profile. But the longitudinal change in amount of forces exerted on those appliances by lips has not been studied yet.
The purpose of this study was to measure the upper lip press u re on prosthetic appliance longitudinally. As for the preliminary study, lip pressure during rest and some functional events were recorded by miniature pressure sensors attached to tooth surface and compared with those results of control non-cleft lip and palate subjects. Maximum value and potential energy of those lip pressure were analyzed. Muscle activities of orbicularis oris and masseter on both sides were also recorded simultaneously with surface electrodes. Three cleft lip and palate patients with removable prosthetic appliances and three non-cleft lip and palate subjects with natural dentition were selected.
Following results were obtained.
1. Larger values of maximum lip pressure were measured in cleft lip and palate patients than control subjects for events like pushing lips forward.
2. Larger amount of potential energy of lip pressure were obtained in the event of pulling upper lip downward in the cleft lip and palate patients.
3. Overall activities of orbicularis oris in cleft lip and palate patients were smaller than those of control subjects.

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This study was carried out to investigate oral and nasal airflow of cleft palate patients during sound production. A Flow Nasality Graph (FNG, Rion Co. ) which measures and displays oral and nasal airflow simultaneously was utilized for data sampling, coupled with a Sound Spectrograph (SG, Rion Co. ) to determine the timing of sound production of each syllable. Preliminary experimentation indicated that the most efficient way to appreciate oral and nasal airflow during syllable production is to express it in terms of Nasal Air Flow Ratio (NFR: the ratio of the amount of air expired from the nose to the amount of air expired from the nose and mouth combined). Our subjects consisted of twenty normal controls (ten males and ten females,24 to 26 years) and ten patients with repaired cleft palate (four males and six females,6 to 31 years). Target syllables were /a/, /i/, /pa/, /pi/, /sa/, /asa/, /if i/, /ma/ and /mi/.
Results obtained were as follows.
1. The FNG could provide reliable and valuable data about NFR.
2. Normal subjects exhibited a difference between the NFR of non-nasal syllables and that of nasal syllables. We were able to statistically plot the normal ranges of their data.
3. Cleft palate patients without speech aid appliances exhibited a larger NFR in non-nasal syllables than normal subjects. However with speech aid appliances NFRs of non-nasal syllables were similar to th ose of normal subjects.
4. NFRs of nasal syllables of cleft palate patients were similar to those of normal controls.
5. NFRs of vowels showed little relationship with the listeners' judgement of hypernasality, but NFRs of plosives and fricatives related closely with listeners' judgement of nasal distortions.

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Chromosomal analysis of leukocytes was performed on cleft lip and/or cleft palate patients(probands),separating them into isolated cases and multiple-occurring cases.
Chromosome abnormalities, including heteromorphisms, were found in 5 cases out of 43 multip occurring cases (11.6 %). There were no cases with certain chromosome aberrations in the 66 isolated ca except for one suspicious case.
The cause of the high i n cidence of chrorosome abnormalities in the multiple-occurring cases is not de Since the type of aberrations observed were variable, they may not be directly related to the etiology clefting.

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From the clinical view point, one of the important treatment objectives of the orthodontic treatment for cleft lip/palate patients is to improve the anterior crossbite.
The changes of their profile revealed in their ce p halometric radiographs in UCLP group before and after the anterior crossbite correction were compared to non - cleft patients with the same conditions.
The results were as follows:
1. In UCLP group, correction of the anterior crossbite is mainly due to the labial proclination of maxillary incisors.
2. Clockwise rotation of the mandibles and lingual inclination of the lower incisors were observed in both groups.
3. The limitation of the profile changes in the UCLP group suggest that the maxillary protraction technique or other disciplines must be considered for these malformed occlusions.

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In order to clarify the effect of palate surgery on the maxillary growth in complete bilateral cleft lip and palate, maxillary growth with two-stage palatal closure, by our own method based on Perko' s technique, was compared to those with mucoperiosteal palatal pushback operation. After lip repair by Manchester's at age 5 months, one group (Bil-T Group) of patients received two-stage palatal closure which include primary veloplasty at age 20 months and hard palate closure at age 5 year 10 months.
Another group (Bil-S Group)received mucoperiosteal palatal pus hback operation at 20 months. A longitudinal and three-dimensional maxillary growth was monitored by the measurement of maxillofacial models obtained from each patient. Non-cleft subjects were classified as a control group to match the cleft groups by age and by body age.
The results showed that t here was no maxillary growth difference between the Bil-T group and the Bil -S group in any dimensions studied, and that the growth inhibition in height of the maxilla of both Bil-T a nd Bil-S groups became more remarkable compared to the control group after lip and palatal surgery. These results may indicate that careful consideration is needed for the choice of two-stage p alatal clousre in cases with complete bilateral cleft lip and palate.

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It is i mportant to investigate maxillofacial development in cleft lip and palate by using the facial standard points just after birth. We developed an impression method for a three dimensional maxillofacial model in newborn babies with cleft lip and palate. With this method, facial standard points including Tragion and Entkathion on both sides and the maxilla are impressed at one time without general anesthesia. The baby should be kept from drinking at least 5 hours before impression to prevent vomiting and air way obstruction. The 7 distances between the 6 points on the maxillofacial model compared with those on the face of the baby during sleep show that this model can be used reliably to study maxillofacial growth in cleft lip and palate.

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