Cephalometric radiographs of cleft lip and/or cleft palate patients taken at the time of either cheiloplasty or palatoplasty were analyzed in order to see the variations in craniofacial morphology with in the same cleft type.
The samples studied were 392 lateral head films consisting of 48 of unilateral cleft lip (UCL),110 of unilateral cleft lip and alveolus (UCLA),129 unilateral cleft lip and palate (UCLP), and 105 of isolated cleft palte (CP). Samples of any patients with associated syndrome were excluded. Bilateral cleft lip and/or palate were too few to analyze statistically, so this cleft type was not studied.
The measurement of ten dimensions and seven angles were use d for the analysis of craniofacial morphology and body weight and height were used to evaluate the patient's body structure.
1. The samples of each cleft type were first divided into male- and female-group, and the sex differences in body structure as well as craniofacial morphology were studied.
No sex differences were observed in UCL. Body structure was larger in the male group in UCLP and CP. The size of cranium (Ba-V, G-Op), the cranial base length (S-N, N-Ba), and the upper facial heig ht (N-Ans) were found to be significantly larger in the male group in UCLA, UCLP, and CP. In U CLP, mandibular length was shorter in the female-group.
2. Cluster analysis was next made to see whether each cleft type could be further classified into subtypes.
The female-group of UCL, UCLA, UCLP and CP were significantly grouped into three subtype s (good, moderate, and poor facial growth). On the other hand, the male group of UCLP and CP was divided into two subtypes (good, poor facial growth).
The size of cranium, cranial base length and upper facial height were selected as the best discriminators in the cluster analysis of the types of cleft lip with or without cleft palate.
In CP, the mandibular length (Go-Me) was selected, in addition to the above five items. In the case of CP, significant differences were observed in the occurrence rate of associated anomalies among the three subtypes thus classified.

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The objective of the present study was to establish differential diagnosis in anterior crossbites incident to the patients with cleft lip and palate. The control group, non-cleft patients, with anterior crossbites were used in such a manner that the orthdontically treated was designated as "easy" in contrast to "difficult" for the surgically treated group.
On lateral cephalog r ams from these groups the "Showa" appraisal was tested if it possibly lent itself to discerning difficulty in the orthodontic treatment in an attempt to correct the anterior crossbite. "Showa"appraisal defined here in composed of two cephalometric variables, one of which is called AYB angle newly devised by Shibasaki and Fukuhara (1985), and the other is known as Bite Index (B. I. ) introduced by Komori and Suzuki (1962). As a result of statistical examination both variables turned out to be valid to substantiate the purpose of the present study.
Linear discriminant function was obtained as follows:
Z= 1.92479X1 +0.74137X25.54610
Mahalanobis' generalized distance D2=10.5691
X1=AYB X2 = B. I.
In an application of the above described function to UCLP patients classified into threee groups according to Hellman's dental development stages, those discriminated as difficult cases accounted for 3.9%in II A- II C (deciduous dentition group),14.9% in III A-III B (mixed dentition group) and 26.5% in III C-(permanent dentition group) respectively.

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Anthropometric analysis was carried out on the soft tissue of the face in unilateral cleft lip patients. The subjects consisted of 37 CL (cleft lip with or without alveolar cleft) and 26 CLP (cleft lip, alveolus and palate). Fourteen points were selected and marked, then distances were estimated by slide calipers direct ly on the patient's face at pre- and post operation,2 weeks,1 month,3 months and 1 year after lip repair.
The results were as follows:
1. The distance between the internal eye angles in CLP was significantly larger than that in CL.
2. In the presurgical stage, the lateral deviations of columellar base and nasal ala in non-cleft side were affected by the magnitude of cleft width.
3. The relapse-ratio of columellar base, which had been shifted correctly on the midline immediately after the operation, was 19 % in CL and 25 % in CLP after one year. The rapidity and degree of relapse w ere affected by the magnitude of cleft width.
4. Both lateral nasal alas, shifted medially after the operation relapsed the most in the first 2 weeks. After that, relapse tended to cease on non-cleft side but gradually continued on cleft side.
5. The marginal length of the naris on cleft side became longer than on non-cleft side 1 to 3 months after the operation.
6. The difference between vermillion border length on cleft side and on non-cleft side after the operation was approximately the same as before the operation.
7. In those cases with less difference between the lateral vertical lip length on cleft side and on non-cleft side before the operation, the vertical length on cleft side tended to become longer than on non-c left side after the operation.

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Among cleft palate patients, constricted maxillary dental arches with collapsed maxillary bones are the common clinical features. Some factors may be considered for this, however, palatal scar tissue after palatal surgery is the most suspectable one. Therefore orthodontists have to consider maxillary expansion as an inevitable procedure for these patients. In the present study, the author performed lateral expansion following experimental palatal surgery and observed morphologic changes of the palatal mucosa in order to evaluate the response of palatal mucosa to the expansion force.
Wistar stain rats 3 to 4 weeks postnatal age, u nderwent experimental surgery in which the mucoperiosteum on the midpalatal suture was elevated and removed. Six weeks after surgery, an expanding apparatus was placed on the bilateral first molars. The animals were sacrificed on 1st,3rd,14th,21st,28th,35th and 42nd days after expansion. Mesurement of the width of the maxillary arch was performed by soft X-ray as well as histopathologic examination.
1. Six weeks after surgery, the width of the maxillary arch of the surgery group decreased more than that of the normal palatal group. It was concluded that palatal surgery inhibited the lateral growth of the maxillla.
2. The duration for the expansion in the surgical group took longer than that of the normal palatal group.
3. In the analysis using the soft X-ray and histopathologic examination, there were no differences between both groups in response to the expansion at the midpalatal suture. However, in the palatal muco s a, the bundles of the collagen fibers which appeared during expansion in the surgical group, were thin whe n compared to the ones in the normal group. In addition, the thin collagen fibers which were observed du ring expansion remained longer in the surgical group.

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While there have been many analyses of the facial deformity of the cleft lip patient in the static state, there have been no reports of studies made of it in the dynamic state.
In this study, we analyzed the movements of anatomical points ar o und the lip and nose at the time of crying in control and cleft lip patients.
Using an actual-size Polaro i d camera (CU-5 Land Camera, Polaroid), these anatomical points of 48cleft lip patients (mean age: 3.5±0.3) were measured at rest and when crying. Ten normal infants (mean age: 3.2±0.2) served as the control group.
The results were as follows.
1. The point of alar and columellar base
Both of these points moved later a l l y in the control group. No movement was observed in the incomplete cleft lip group on the cleft side, while movement which seemed to widen the cleft was observed in the complete cleft lip group on the cleft side. Conversely, on the noncleft side, movement in the same directio n but to a greater degree than in the control group was observed. In the bilateral cleft lip gro up, the movements of the alar base were the same as in the control group, but the movements of the columella r base could not be measured because these points were concealed behind the nostril rim.
2. The peak points of Cupid's bow
The peak point of Cupid's bow in the control group and on the noncleft side of the unilateral cleft lip group moved to laterally. This movement was greater in the unilateral cleft lip groups than in the control group. However, this same point on the cleft side of the unilateral incomplete and complete cl eft lip groups and bilateral cleft lip group could not be recognized.
3. Mid point of Cupid's bow
In the control gro u p, this point showed no statistically significant movement in crying. On the noncleft side in the incomplete and complete unilateral cleft lip groups, this point moved laterally. In the bilateral cleft lip group, this point moved only in the cranial direction.
These findings suggest that dynamic state of the lip is different in th e s e groups, especially between the incomplete and complete unilateral cleft lip groups.

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This article describes prosthetic procedure to improve occlusion and esthetics of a cleft palate patient with reference to speech articulation. A method was designed to determine the mandibular positions during speech in which three phenomena: (1) path of the mandibular movements (MKG), (2) spectrogram of voice, and (3) voice sound were simultaneously recorded on the same frame of 16mm motion picture films. The voice spectrogram was analyzed by Speech Spectrographic Display (S. S. D). The method was applied to predict acceptable occlusal vertical dimension (O. V. D) for a cleft palate patient before prosthetic treatment.
The O. V. D of the patient was gradually increased by setting resin blocks on the occlusal surface of the mandible. At various O. V. D, the mandibular positions during pronunciation of /s/, /1/, /m/ were observed. The suitable range of O. V. D was estimated from these observations. Within this range, the maxillary overlay denture for diagnosis was prepared. The presence of the denture, /m/ position maintained a constant level and proper amount of interocclusal space existed during speech so that the O. V. D was assumed to be suitable. Then, at the same level of O. V. D, the Konuskronen telescope denture was constructed.
The palatal contour of the denture was examined using "Palatography including lingual and occlusal surfaces of teeth" and modified so as to show proper tongue-to-palate and teeth contact. In consequence, at the tenth month follow-up visit, satisfactory results in appearance and function were observed.

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The present study was intended to ascertain the occurrence of congenital absence of permanent teeth in association with cleft region in 165 orthodontic patients,89 males and 76 females, with cleft lip and/or palate. The full-mouth radiographs, gnathostatic casts and dental clinical records of each patient were evaluated.
The findings obtained were summarized as follows;
1. The majority of cleft-patients,70.9% of the total number, exhibited cleft lips, alveolus and palate (CL P), which were observed more frequently in males (69 cases) than in females (48 cases). Cleft lip with or without cleft alveolus (CL) were found in 22 cases (13.3%), and is o lated cleft palate (CP)were in 26 cases (15.8%) out of the samples (Table 1).
2. Cleft-patients were ascertained to be afflicted with the additional tooth absence with the frequency of 64.2%.
The congenitally absent teeth most commonly found in association with cleft were the upper lateral incisors, solely or in combination with the other teeth (Table 2).
Particularly in unilateral and bilateral CLP, the absence of the upper lateral incisors were observed with frequencies from 69.4% to 80.0% in both sexes.
In regards to the absence of the other te e th, excluding the upper lateral incisors, it actually represented only a small percentage for CLP and also for CLP and also for CL patients. Whereas, it was not ed to occur with relatively higher percentage in CP patients.
3. Asymmetrical absence of upper lateral iincisor in the cleft region alone was most frequently observed in unilated CLP patients (Table 3). For bilateral CLP, the absence of lateral incisors in both sides of cle ft regions were found in the great majority of cases (Table 4).
4. The fact that the ratio of the combined absences to the whole absences (sole and combined) of the upper lateral incisors occurred in association with CLP were assessed (Table 5). Especially in unilateral CLP, combined absences were observed with t he frequency of 66.7% in cases afflicted with symmetrically absence of the upper lateral incisors.

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For the purpose of establishment of proper orthodontic management on each cleft type, in the present study, dento-skeletal morphological analyses were taken of 32 bilateral cleft lip and palate cases and their orthodontic treatment planning was surveyed from the files of Orthodontic Clinic of Tokyo Medical and Dental University.
As a result of investigation, a high incidence of rotation on upper central incisors was observed, and the percentage of congenital missing of upper lateral incisors and upper second premolars was high. Cross bite on lateral segments was recognized in most of the cases. Shallow palate and oro-nasal fistula were observed also in many cases. Rotation and mobility of premaxilla were recognized in one third of the cases.
Compared with non-cleft cephalometric data, patients with bilateral cleft lip and palate sho w ed lingual tipping of uppper incisors, and have a tendencies toward retarded mid-face and large mandibular body.
Main orthodontic treatment planning for these cases were the expansion of upper arch and the alignme n t of individual tooth. Chin cap for the growth control of mandible was intended in about 30% of the cases.9% of the cases were diagnosed as orthodontic-surgical.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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