In order to elucidate the pathogenesis of cleft lip, a single intraperitoneal injection of 0.2mg/kg vincristine was performed in rats on 8th day and 12 hours of gestation and embryos were extracted during the period from 10th day and 18 hours to 14th day and 12 hours of gestations at 6-hour intervals for observation by scanning electron and light microscopy, the result of which described as follows.
1. Cleft lip were observed in 69.5% of the embryos during the period from 14th day and 0 hour to 14th day and 12 hours (median cleft lip 25.4%, lateral cleft lip 44.1%).
2. Variable hypoplasias of facial processes were observed, and two types of hypoplasias were recognized in them. One was the extreme hypoplasia or aplasia of the frontal processes, the other was the h ypoplasia of the medial and the lateral nasal procsses, especially the lateral nasal processes.
3. Differentiation of the surface epithelium on facial processes was delayed, and the number and the density of the mesenchymal cells were low.
4. The incidence of spheroidal particles, filopodial projections and cellular processes on the surface epithelium and the incidence of the pycnosis figures in epithelial cells and mesenchymal cells were low in the inferior portion between the medial and lateral nasal processes.
5. Variable incomplete fusions such as the narrow inferior portion of the medial nasal processes toward the lateral nasal processes in fusion or a lack of fusion were observed.
6. All of these alterations may contribute to the pathogenesis of cleft lip induced by vincristine. Especially, median cleft lip may be due to the hypoplasia or aplasia of the frontal process, and lateral cle f t lip may be due to the hypoplasia of the lateral nasal process.

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Family study on 591 propositi with CL/CP was performed except for 16 propositi with syndromes associated with CL/CP and multiple malformations.
Results are summarized as follows;
1. Affected rates in relatives of the propositi with CL(P) were 2.26% in first degree,0.37% in second degree,0.40% in third degree. The frequencies in these three degrees of relatives were about 16.2 times,2.6 times, and 2.8 times, respectively, that found in the general population.
2. Affected rates in relatives of the propositi with CP were 1.64% in first degree,0.32% in second degree,0.11% in third degree. The frequencies in these three degrees of relatives were about 41.7 times,9.4 times, and 2.9 times that found in the general population.
3. Affected rates in various relatives of the propositi with CL(P) and CP were similar to Edward's expected rates in polygenic inheritance, and observed relative frequencies in sibs of the propositi with CL(P) and CP were same as Penrose's expected relative frequencies in polygenic inheritance.
4. In the propositi with CL(P), affected rates in three degrees of relatives of male propositi were smaller than those of female propositi. On the other hand, in the propositi with CP, affected rates in three d egrees of relatives of male propositi were larger than those of female propositi.
5. Affected rates in three degrees of relatives of propositi with BCL(P) were larger than those of propositi with UCL(P). But affected rates in first and third degree of relatives of propositi with CLP were smaller than those of propositi with CL.
6. In the propositi with CL(P), affected rates in first and third degree of relatives of propositi without other congenital malformations were larger than those of propositi with other congenital malformations. In the propositi with CP, there was no affected indivdual in the three degrees of relatives of propositi with oth e r congenital malformation.
7. In the propositi with positive family history, affected rates in sibs were 3.9% in CL(P) propositi,14.2%in CP propositi, and those of the propositi without positive family history were 3.09% in CL(P) prop o siti,0% in CP propositi.
8. In the parents of CL(P) propositi, the frequencies of contanguineous marriage in first cousins and other relative were larger than those in the general population. The frequency of first cousine marrige i n the parents of CP propositi was larger than that in the general population.
9. According to Falconer's procedure, heritability of liability were estimated as 65.4±2.4% for CL(P) and 18.0±13.6% for CP.
These results a re suitable for the prediction of multifactorial threshold model, so that both CL(P) and CP are polygenetic traits which are dependent on a lot of genes and enviromental factors.

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In order to clarify the development of vascular structures during formation of the secondary palate, vascular patterns in the palate were studied three dimensionally in normal and vitamin A treated Wistar rats by india ink perfusion and resin cast preparation.
The results are summarized as follows.
1. The vascular plexus of the palatal shelves before reorientation was denser in the oral side than in the nasal side in both normal embryos of 15.5 days gestation and cleft embryos of 16.5 days gestation. T h e findings indicate that different proliferative activities in the two regions resulting from different bl o od supply may contribute to the reorientation of the palatal shelves.
2. In the normal group the vascular plexus of the palatal shelves during the period of medial extension were stretched laterally, possibly because vascular regeneration could not catch up with the rapid growth o f the palatal shelves. On the other hand, such chasges were not observed in the cleft group in which the palat a l shelves showed no growth toward the midline.
3. In the normal group, many small spherical masses were observed along the medial edge of palatal vascular plexus in the resin cast preparations of the palatal shelves just before and during f usion, indicating that some change has taken place in the capillary wall before forming anastomosis.
4. In both groups, dense vascular distribution was observed in the area of bone formation to meet active osteogenesis.
5. Compared to the normal group, reorientation of the palatal shelves and formation of the maxilla were delayed by 1 to 1.5 days in the cleft group.
6. Although ultimate development of the vascular structure was attained in the cleft group, vascular development was delayed and was associated with alterations in the microvascular structure such as the thickness of capillary vessels and the density of vascular plexus.

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To quantitatively evaluate hypernasality, pronunciation of the Japanese vowel /i/ by eighteen patients diagnosed as having cleft palate or congenital velopharyngeal incompetence and seventeen normal subjects (controls) was analyzed acoustically by cepstrum analysis. Spectrum envelopes obtained by the cepstrum method were evaluated every 1/3 octave to obtain the mean level of each band.
Twenty listeners evaluated twenty-six speech samples for hypernasality on a five interval scale of 0 to 4.
Relations between the first perceptual factor of hypernasality and the levels of 1/3 octave bands wer e examined. The results were as follows:
1. Spectral characteristics of hypernasality were the raising of the level between the first and second formants and reduction of the level in the second and the third fomant regions.
2. Two factors were obtained by factor analysis of the judged scores. The first factor, which accounted for 75% of the total variance, was the consensus perception of hypernasality. The second factor, whi ch accounted for 7%, was the individual listeners perception of hypernasality differences.
3. Two kinds of average levels of three 1/3 octave bands were highly correlated with the first perceptual factor of hypernasality. One was the mean level of the 2/3 octave, the 1 octave, and the 4/3 octa ve above the first formant. The other was the mean level of the 3 octave, the 10/3 octave, and the 11/3 octave above the first formant.

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There have been many epidemiologic and experimental studies on the relation between hematological changes during pregnancy and fetal development, but there is no study concerning hematological changes related to cleft lip and/or palate. So, this study was aimed to find out the relation between hematological changes during pregnancy and clefting in the mouse.
Findings are as follows:
1. Hematological data of non-pregnant A/J mouse are; WBC 7.3±2.32x103/mm3, RBC 1045±58.1x104/mm3, Hb 17.3±0.78 g/dl, Ht 48.3±3.33%, MCV 46.2±1.21 //3, MCH 16.6±0.59, u, ug, M CHC 35.9±1.66%.
2. Compared with the non-pregnant control, RBC, Hb and Ht dropped appreciably in pregnant A/J mouse.
3. A/J mothers which had cleft embryos seemed to be more anemic than those of no cleft embryos during pregnancy.
4. Cleft palate may be induced by anemia, which will influence corpuscular constants, in the 10th day of gestation of A/J mouse.

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In order to elucidate the mechanism of sucking behavior of normal infants and to examine the effects of Hotz's resin plate on the improvement in sucking behavior of cleft lip and palate (CLP) infants, we have developed an ultrasonographic system to record the echo images of the sucking behavior and then to analyze the images with computer graphics. This system is useful because the dynamic sucking behavior can be observed under normal bottle feeding conditions. The subjects examined consisted of 10 CLP and 2 normal infants. In the sucking behavior of normal infants, two type of waves, large or small, were clearly seen. The large waves represent the overall movement of the tongue and the small ones indicate partial movements, which propagate independently of the large waves. In CLP infants without the resin plate, the tongue action was small toward the upper lip, alveolar ridge, and palate. When the resin plate was set, the sucking behavior was improved and became rhythmical, continuous, and long in stroke like that of normal infants.

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A rare case of cleft palate combined with nasopharyngeal teratoma is reported.
The patient was a six-month-old girl. The tumor was in the nasopharyngeal cavity, and was visible through the cleft of the palate. It was consisted of two approximately spherical parts: a solid anterior part and a cystic posterior part. It was slightly mobile and not adhering to the palate.
Preoperative CT scanning revealed a tumor which showed partial bonely density region in the nasopharyngeal cavity.
Complete surgical removal was performed under general anesthesia, confirming the presence of the tumor in the nasopharyngeal cavity, and revealing its stalk within the remnant of Rathke's pouch.
After removal, the tumor was diagnosed histologically as a teratoma because of its two germinal layers: mesoderm (bone, cartilage, bone marrow), and ectoderm (central nervous tissue and mucous gland).
The remnant of Rathke's pouch observed during the operation drew some embryological in terest in the cosideration of the origin of the tumor.
Prevention by the teratome of palatal fusion was considered to have been the reason for the incomplete cleft palate.

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To evaluate the effectiveness of visual training with Dynamic Palatography(DP) on modifying compensatory articulation, the therapeutic process for the /s/ sound was assessed objectively using the original assessment method in five cleft palate patients who exhibited Japanese Palatal Articulation and Japanese Lateral Misarticulation and were trained in a similar procedure.
Method: The process of learning each syllable is divide d into five stages ( I V) according to DP patterns and the direction and amount of the air stream. Then, the five stages are subdivided into eight levels of application, progressing from isolated sounds to natural conversational speech. In addition to the 40 learning levels, four levels of basic training to correct abnormal tongue placements are included at the beginning of therapy. In general, training progressed from one level to the next. When correct responses were obtained at a criterion of 80% or more, the task was judged to have been successfully completed. The whole therapeutic process is assessed by progressing these training levels.
Results: 1) The severe group who exhibited remarkable compensatory articulation required more therapy sessions for the /s/ sound than did the slight group.
2) The patients treated with DP required fewer therapy sessions for the /s/ sound than the patients treated without it.
3) Although the patients treated with DP required many therapy sessions in basic training, they could readily learn the /s/ sound once they learned to avoid elevating the dorsum of the tonuge.
4) The patients treated without DP required many therapy sessions in order to learn slight changes in palato-lingual contact.
As a conclusio n, training procedure with the DP is more effective than without DP for the treatment of misarticulation in cleft palate patients.

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A ne w type of speech appliance was invented for effective speech therapy and prevention of misarticulation in cases of various types of velopharyngeal incompetence. The new appliance (Bulb-PLP)' has both advantages of speech bulb for the velopharyngeal function and of palatal lift prosthesis for the velum function. Procedures and adjustment are described in detail. The adaptability of the appliance in the physiological or anatomical environment is also discussed. The authors recommend the new appliance (Bulb -PLP) described here as a very effective approach to the speech problems in various types of velopharyngeal incompetence.

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Bone grafts in the form of cortico-cancellous blocks were prepared from the iliac crest of two patients aged 14 years with unilateral cleft lip and palate, and these were transplanted in the alveolar clefts of the individual patients, respectively. Within 5 or 8 years after transplantation in the patiens, botn grafts were resorbed spontaneously and reduced to less than half in size, forming a slender bone bridge with low marginal bone-level. It was also found that these bone grafts continued to resorb for a much longer period as compared with cancellous bone chips when used as autologous grafts in other patients. Based on these results, it is suggested that cortico-cancellous bone may not be suitable for the transplantation of bone grafts in the alveolar clefts, and that preferably particulate cancellous bones should be used.

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Chewing efficiency was investigated in 25 children with cleft lip and/or palate in a prepubertal peried (test group; 5 isolated cleft palates,12 unilateral cleft lip and palates, and 8 bilateral cleft lip and palates) and 12 children with acceptable good occlusions (control group) based on the method devised by Manly et al (1950).
Results obtained were as follows:
1. The average chewing efficiency for the control group was 100.9% (SD=32.6).
2. Children with isolated cleft palate revealed an average chewing efficiency of 53.4% (SD = 34.3). For those with unilateral cleft lip and palate and for those with bilateral cleft lip and palate, the chewing efficien cies were 28.4% (SD=13.0) and 15.1% (SD= 6.6) on avarage, respectively. The differences of chewin g efficiency between control group and test group were statistically significant (isolated cleft palate was sig n ificant at P<0.05, unilateral and bilateral cleft lip and palate were significant at P<0.001).
3. The cumulative percentages of pulverised peanuts on 4,6 and 8 meshed screens in the unilateral and bilateral cleft lip and palate group were significantly higher (P<0.001) than those for control group.
4. In regard to those who revealed crossbites in the posterior segment in the experimental group, significant difference was not determined for the chewing efficiencies between the segments with an d without cross-bite.
5. The chewing efficiencies in the affected and non-affected sides did not differ in children with unilateral cleft lip and palates.

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Treatment results in 31 patients with congenital velopharyngeal incompetence (CVPI) compared with 30postoperative cleft palate patients showing velopharyngeal incompetence were presented.
The results are as follows.
1. Treatment results in CVPI patients were poorer than that in cleft palate patients. Ten percent of CVPI patients showed velopharyngeal incompetence (VPI) and 26% of them showed hypernasality though the VPI was improved.
2. Unsatisfactory results were obtained and a long period was required to improve velopharyngeal function in subjects with the velo-facial syndrome.
3. Prosthodontic treatment using speech aid appliance was effective for CVPI patients for improving of velopharyngeal incornpetence(VPI). In 6 cases(19%) of CVPI patients and 3 cases(10%) of cleft palate patients, speech aid appliances were removed after acquiring adequate velopharyngeal closure wi t hout surgical treatment.
4. Excellent results from surgical treament were obtained in cases who acquired good velopharyngeal closure using speech aid appliance.
5. Five patients under 3 years old with CVPI and with slight VPI obtained good results by speech therapy.
6. Patients with the velo-facial syndrome and those classified as type II required longer periods than cleft palate to acquire adequate velopharyngeal function by the prosthodontic procedure. The improveme nt process in CVPI cases without velo-facial syndrome and those classified as type I was simil a r to that in cleft palate, though the improvement rate was a little lower.
7. From these results, it was considered that prosthodontic treatment or speech therapy, or combined therapy of both should be selected as a primary treatment for CVPI. Indication of surgical treatment should be decided according to the results of these treatments.

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We have discussed the clinical records of 1,730 patients with cleft lip and/or palate that were kept in custody of the office for materials on cleft lip and/or palate at the 2nd Department of Oral and Maxillofacial Surgery, School of Dentistry, and Aichi Gakuin University for the past 10 years, and obtained the following conclusion.
1. Of these 1,730 patients,1,135 (65.6%) were those who were primarily operated on for this disease and those on a waiting list. When classified by the types of disease, cleft lip was treated in 244 (39.1%), cl eft lip and palate in 283 (45.4%) and cleft palate in 97 (15.5%) males, while cleft lip in 171 (33.5%), cleft lip and palate in 179 (35.0%) and cleft palate in 161 (31.5%) females, which were almost identical to the results of our investigations on the overall number of newborns in Aichi prefecture.
2. When the patients were classified by their communities,1,197 (69.2%) patients lived in Aichi prefecture,452 (26.1%) in Nagoya city,491 (28.2%) in Owari and 254 (14.9%) in Mikawa. Those living in the three prefectures of Aichi, Gifu and Mie registered 92.4% of all patients, with 241 (13.9%) living in Gifu prefecture,160 (9.3%) in Mie prefecture,32 (1.8%) in Shizuoka prefecture,15 (0.9%) in Nagano prefect u re and 85 (4.9%) in the other communities.
3. It was surmised from the overall number of newborns we obtained that about 60% from Aichi prefecture, and about 30-50% from Gifu and Mie prefectures visited our department.
4. Although the patients who were treated at our department belonged to a variety of age brackets,1,304patients were children younger than 15 years who registered 75.4% out of all the patients.
5. An increase and decrease of the patients who were primarily examined at our department were almost in parallel to the changes in the spontaneous incidence.
6. In terms of the ratio of primary operations and repeated plastic surgery, the primary operation registered as high as 45.2%-60.8%. The primary operative ratio declined during the past 5 years, but this was attributable to a decline of a relative ratio due to an increase of patients who received repeated plas tic surgery.

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