The purpose of this study is to learn about the concerns of mothers regarding cleft palate children. The concern of mothers having normal children was used as the control. The subjects were 80 children having cleft palate (isolated cleft palate 43 cases and unilateral and bilateral cleft lip and palate 37 cases,3 months to 6 years old) and 163 control children (2 months to 5 years 11 months) and their mothers. The mother's concerns regarding cleft palate children and the mother's concerns of control children were investigated using a questionnaire and interviews. The surveys for mothers of cleft palate children were carried out at the time of lip repair, palatoplasty and a post-operated period of one to four years.
The results were as follows:
1. Mothers of cleft palate children were mostly concerned about the nature and implications of the cleft. They differed from that of the control group.
2. In mothers of cleft palate children the main concerns of the mothers tended to vary with the age of the child and the stage of treatment and differed according to cleft type.
3. A common concern of mothers having a cleft palate child at any age was “speech”. As the child got older, those mothers were concerned about “social adjustment (especially kindergarten)”, “dental caries” and “malocclusion”.
4. In addition, mothers of children with CLP were concerned about “psychological problems” and “reoperation”.
These results seem to suggest to necessity of counseling sessions with mothers of a cleft palate children and the involved professionals during the treatment period.
These sessions should be designed to inform the mothers about the mental and physical development of the children as they grow older, especially the implications of the cleft after lip repair and palatoplasty and to help the mothers make mental preparation and progress for the problems of their children.

View full abstract

In order to clarify the relation between eleft lip and/or palate and the mother's anemia, A/J-Wv^v/+ /AG and CL/Fr-W^v/+/AG congenic mouse strains were newly bred by introducing anemic gene from C57BL6/J-W^v/+mouse strain into A/J and CL/Fr mouse strains which are the spontaneous cleft lip and/or palate model animals.
Hematological findings, proportion of implantation, survived fetuses, resorption and dead fetuses, and incidence of cleft lip and/or palate were compared between the new strains and original strains.
The results were as follows.
1. The new strains were found to be hematologically similar to the original strain, C57BL6/J-W^v/+, before pregnancy.
These hematological findings showed anemia even on the 10 th day of gestation which is generally considered to be the most influental day for cleft lip and/or palate appearance.
2. The proportion of implantation, survived fetuses, resorption and dead fetuses were were found to be similar to the original strains, A/J and CL/Fr.
3. Compared with the original AO the new A/J-W^v/+/AG was similar in that cleft lip alone was not found, but there was appreciably higher incidence of unilateral cleft lip and palate, and cleft palate alone.
In the case of CL/Fr, the new CL/Fr-W^v/+/AG was similar to the original in the incidence of cleft lip alone but totals of cleft lip and palate, cleft palate alone was appreciably higher.
Conclusion.
There appears to be no relation between mother's anemia and development of cleft lip alone. A relation is suspected between mother's anemia and development of cleft palate alone.

View full abstract

We have investigated the process of physical, mental and articulatory development in a case of cleft lip and palate child during the babbling period. The subject is a boy with left side cleft lip and palate. According to periodical observation at the age of 6 years, we found that he was normal and acquired favorable velopharyngeal function and normal articulation without articulation therapy. From the age of 6 months to 20 months, we recorded on video tape scenes of the subject and his mother for 30 minutes at his home once a month, taking notes and photos on occasion. As for his articulation, all of the voices recorded during a period of 30 minutes were transcribed one by one. His developmental process was studied on the basis of video tapes, written notes and photos.
Our observations were as follows;
1) Studying the number of bilabials, palatals and velars except glottals, there was an increase in number at the age of 10 months when he came to utter repetitive babblings activity and also at 15 months when he began to make imitation of speech sounds. It was noted that the differentiation of articulation was developed in the periods when the repetitive babblings and the imitation of the speech sounds appeared.
2) The articulatory development of meaningless speech sounds was far behind: He could hardly articulate alveolars and alveolo-palatals even at the age of 20 months when he began to articulate meaningful speech sounds. His articulatory ability at the age of 20 months was the same level of a normal 6 months old infant. As for alveolars and alveolo-palatals, the differentiation process was observed to be delayed further.
3) At the age of 6 months, the subject showed developmental retardation. This was because his mother could not give enough care owing to her shock at the birth or anxiety about medical treatments or childcare. As his mother came to recover and began to have a closer relationship with him, his development was promoted. However, he was still found to have developmental retardation even at age 20 months.
It seems important to support the mother such as giving counseling in order to have a good relationship with her child at an early stage or giving advice for the outlook of the treatments or childcare.

View full abstract

The sucking behavior development was studied in 6 incomplete and 26 complete cleft-lip-and-palate (CLP) infants with Hotz's resin plate. The data obtained were compared with those for 15 incomplete and 6 complete cleft-lip (CL) infants. A sucking behavior monitoring system was made and used to record the pressure in the nipple, burst time, sucking rate, and actual sucking time ratio. Multivariate analysis was carried out to reveal the relationships between the improvements of the sucking bahavior and several factors such as weight gain, total volume of milk per day, and feeding time. The following results were obtained.
1. Factor analysis shows that three factors out of 12 variables are correlatable to the sucking abilities of the CLP and CL infants. For the CL infants, the first factor is considered to indicate the immaturity of sucking, the second the accomplishment, and the third the development. For the CLP infants, the first factor represents the development of sucking, the second the immaturity, and the third the accomplishment. These factors consists of the sucking rate, positive pressure in the nipple, negative pressure in the mouth, and actual sucking time ratio.
2. In both groups, for components were extracted by principal component analysis. For the CL infants, the first component is related to general immaturity, the second to accomplishment of sucking, the third to growth in the newborn period, and the fourth to physical development after the newborn period. On the other hand, the first component for CLP infants is related to growth, the second to fatigue or immaturity, the third to accomplishment of sucking, and the fourth to sucking mechanism development.
3. By cluster analysis, three clusters are found for both groups. The body weight growth rate of CL infants one month after birth has a correlation with the sucking rate and with the average milk volume per day at three weeks. The body weight growth rate two months after birth is correlated with the sucking pattern, the average milk volume per day at six weeks, the positive pressure in the nipple, and the negative pressure in the mouth. For CLP infants with the plate, however, the body weight growth rates at one and two months after birth are related to the sucking rate and to the average milk volumes per day at three and six weeks after birth. These findings indicate that CLP infants are more immature than CL infants in sucking ability.
It was concluded that Hotz's resin plate is effective in improving CLP infants sucking behavior if the plate is implemented soon after birth. However, the development in sucking behavior of the CLP infants is not sufficiently high compared with those of CL and normal infants.

View full abstract

The deviation of individual tooth from the maxillary alveolar arch in unilateral cleft lip and palate (U. C. L. P. ) was quantitatively evaluated by cast analysis. Matrials consisted of 27 sets of dental arch models and alveolar arch models taken from Japanese female, HIC in Hellman's dental age with U. C. L. P. As the control, materials from 20 adult females with normal occlusion were used for the comparative study. The alveolar arch models were made by trimming off all erupted teeth crowns and the alveolar arch line was used as the base line to measure the extent of the labio-lingual transposition and mediodistal rotation. The following results were obtained:
1. Average frequency of the lingoversion in all kind of teeth was more than 70 %. Particularly, more than 80 % of central incisor, the lateral incisor and second premolar in the major segment, and lateral incisor and canine in the minor segment showed lingoversion. However, only the second molar in the minor segment demonstrated more than 50 % frequency of buccoversion.
2. The teeth adjacent to alveolar cleft were distinguished by high medial rotation frequency. Namely, the central incisor adjacent to alveolar cleft, the lateral incisor and the canine in the minor segment demonstrated 92.6 %,100 % and 85.2 % frequency, respectively. On the other hand, the second molar in the major segment showed high frequency of distal rotation.
3. Although any kind of teeth in the major segment did not show any significant correlation between the degree of transposition and that of rotation, a few teeth in the minor segment showed the following correlations.
1) The canine and the second premolar demonstrated a correlation between lingoversion and medial rotation (the canine: r= 0.37, the second premolar: r= 0.47, p<0.1).
2) The lateral incisor and the second molar demonstrated a correlation between lingoversion and distal rotation (the lateral incisor: r =-0.96, the second molar: r =-0.33, p<0.2).
3) The first molar demonstrated a correlation between lingoversion and medial rotation

View full abstract

In an effort to obtain enough retropositioning of the soft palate and to minimize surgical intervention for the construction of dynamic velopharyngeal function, a new surgical procedure in the pharyngeal flap operation was devised.
The method includes: a. dissection of palatal mucosal flaps from the posterior third ot the hard palate, leaving periosteal tissue intact and the neurovascular bundles in place, b. sufficient retropositioning of the soft palate with the transverse incision on the nasal mucosa, c. development of a superiorly based pharyngeal flap from the posterior pharyngeal wall, d. transpositioning of the pharyngeal flap in the soft palate, e. reconstruction of a levator muscle sling, f. complete wound closure of the pharyngeal flap with the palatal flaps from the posterior base to front, g. application of Fibrin Sealant (Tisseel) beneath the palatal flaps and the anterior raw surface on the hard palate for tissue adaptation and for complete coverage of the wound on the palate. The mucosal flap technique provides wide access in the soft palate which may help anatomical correction and the use of Fibrin Sealant induce smooth wound healing. With these advantages, we recommend the procedure for the management of velopharyngeal incompetence.

View full abstract

The team approach in which several clinics work closely in role play is indispensable to treatment of cleft lip and palate patients. This article described the consistent treatment and a medical system for cleft lip and palate patients. An unilateral cleft lip and palate patient had been observed from late of mixed dentition to 24 years of age. The patient was a 12-year-old girl before treatment. The patient had been equipped with jointed band crowns with maxillary right lateral teeth and a removable partial denture with anterior maxillary region at about seven years of age. The patient's frontal face was symmetrical, but with a slightly deformed nose and disagreement between superior vermillion borders. In a lateral view, the nose showed low height. The lower lip had an anterior protrusion. When the jointed band crowns and the removable partial denture were removed, many crowns of permanent teeth that eruped under the dentures had been discalcified. The maxillary right lateral incisor, maxillary left incisor, left lateral incisor and left second premolar were congenitally missing. Cephalometric analysis showed retruded maxilla, with normal chin position. Comprehensive orthodontic treatment had continued from age 12 to age 22. In this period, the patient was improved by Obwegeser-Dal Pont osteotomy, reconstructive surgery of the upper lip, and palatoplasty of the palatal fistula. The following problems in this case were pointed out. Due to lack of appropriate instructions to parents in the early stage, the parents were very anxious about future treatment. Furthermore, It was very difficult to manage dental treatment for patients of this type over the long term considering the growth and development for dentofacial complex. Under the circumstances, the patients had been corrected by persons responsible for requiring a special knowledge and technical skills. We feel that a medical system which is capable of executing treatment plan in accordance with a consistent philosophy should be established, organizing several medical institutions in a regional community.

View full abstract

The speech aid appliance equipped a bulb with 9 electrodes was used for velopharyngeal closure training as visual feedback. This system was used generates a visual display of contact the bulb with soft palate and pharyngeal wall. The Dynamic Palatograh System modified for it.
The subject, an adult with isolated cleft palate, underwent primary pushback operation at age 31. She was applied speech aid appliance for her velopharyngeal incompetence after surgery. The video fiberscope was then used as a training apparatus but she displeased at production of speech sound with nasopharyngeal fiberscope. Therefore, we used this new training system. The results were as follows:
1. The patient performed velopharyngeal closur e during production of vowels, syllables and other units by the training.
2. This training m e thod is useful for patients with speech aid appliance.
3. As compared with fiberscopic feedback training, this method permits natural utterance and self-training without a medical staff.
4. The visual display obscured when secretion adhered to the bulb. Therefore, it may be required the fiberscopy with this method occasionally.

View full abstract