In patients with cleft lip and palate, it is considered that the cases of nasal deformities are related to not only alar cartilage deformities but also maxillary segmental deviation. The purpose of this paper is to present the relation between nasal deformities and segmental deviation of the maxilla.
The subjects were 26 infants with complete bilateral cleft lips and palates who visited the Second Department Oral and Maxillofacial Surgery, Aichi-Gakuin University Hospital.
The results were as follows:
1. Premaxillary protrusion has not so much influence upon the height of nasal tip, but it raises the alar base and Cupid's bow. As a result, the length of columella becomes too short, and theses factors contribute to flat nose impression.
2. Premaxillary lateral protrusion has so much influence upon the lateral shift of nasal tip, alar base, and Cupid's bow.
3. The width of the alveolar cleft has influence upon the lateral shift of nasal tip, the base of columella, the width of nasal ala, and the width of the nasal alar base.
4. The width of lateral segments, both anterior and posterior, has influence upon the width of nasal ala and nasal alar base.
5. The width of cleft paltate has a little influence upon the width of nasal ala and the nasal alar base.

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As a part of development program for the diagnostic system of Japanese misarticulation, the speech analysing system using a microcomputer (NEC PC 9801 VM 21) combined with high-speed palatography was developed, and distorted sounds with Japanese Palatalized Articulation (JPA), often associated with cleft palate speech were analysed.
Twenty-eight cleft palate patients, and one functional misarticulation patient suffering from JPA with sufficient velopharyngeal function, and as a control, thirty-one persons with normal speech served for this study.
Target syllables were normal and JPA of /ta/, /da/,/tsw/,/dzw/ and /sa/, which are judged as JPA in high frequency, and /ka/, /ga/, /kw/ and /gw/ which were often confused with JPA in clinical examination.
Acoustical analysis were carried out by frequency and time domain for these target syllables and the following results were obtained.
1) On the consonant spectrum envelope (SE) normalized for level, the differences between high and low subband level were calculated and defined as Spectrum Envelope Score (SES). As the result, although normal /sa/ and it's JPA could be distinguished, other normal and JPA could not.
2) The maximum level of frequency on the consonant SE was defined as Consonant Peak Energy Frequency (CPF). JPA of /ta/,/da/,/tw/ and /dzw/ were distinguished from normal articulation of them, and /ka/, /da/, /kw/ and /gw/ respectively by CPF.
3) The second and the third formant variance between transient portion was calculated by LPC method (ΔF2, ΔF3). Distinction of normal /ta/, /da/, /tsw/ and /dzw/ and it's JPA were possible by calculation of ΔF2-ΔF3 respectively. However, JPA and it's corresponding velar sound /ka/, /ga/, /kw/ and /gw/ was not distinguished.
4) As for VOT, JPA of /ta/ and /da/ had similar scores to velar sound /ka/ and /ga/respectively different from that of normal sound. But, it was unable to distinctly determine normal and JPA by VOT.
5) As CPF and ΔF2-ΔF3 were considered to be suitable for the quantitative evaluation of JPA from the above mentioned results, multi revolution analysis were carried out on them and the estimated scores from psycho-acoustical judgement. Although a close correlation between the physical judgment score and clinical confusion tendency was proved, correlation between the score and the characteristic noise caused by abnormal tongue movement was not found.

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The effects of artifically induced velopharyngeal (V-P) incompetence on the palatal movement were examined in fifty-six normal subjects.
Vinyl tubes of two sizes (6.5 mm and 5.5 mm diameter) were inserted into the V-P port via naris in order. Electromyographical (EMG) activates of m. levator veli palatini during phonation, blowing and swallowing were estimated and analysed. By altering aperture size at the end of the tube, the influences of intraoral air pressure on EMG were discussed. The strength (pressure) of V-P closure was also measured by use of original devices composed of balloon and microtip pressure transducer.
Results were as follows:
1. EMG activities during phonation and blowing were markedly lowered by insertion of the tube to the V-P port. The lowering was greater in the larger tube. The values of EMG during plosives with larger tube were identical to those during nasals without tube (control). No change was observed during swallowing.
2. The influences of intraoral air pressure on EMG by altering aperture size were minimal during phonation. Meanwhile, EMG activity during blowing increased in accordance with air pressure.
3. The strength (pressure) of V-P closure showed correlation with EMG activity. The strength proved to become weak according to the width of remnant space caused by the balloon in the V-P port.
4. Mean values of sphincteric power measured at the V-P port with the balloon 6 mm in diameter were 110 g in plosives and fricatives,100-200 g in blowing and 220 g in swallowing.
5. These results imply that in the course of treatment on the operated cleft palate patient who need a speech aid, too large bulb must be strictly avoided because it might inhibit the activity. To activate the tightness of V-P closure, progressive reduction of bulb size may be beneficial.

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The purpose of this investigation consists of two categories. First is to clarify the morphological characteristics of the craniofacial structure in the parent group without any history or manifestations of cleft lip and palate, who had cleft lip (CL) and/or cleft palate (CP) children. Second is to find out the family likeness between those probands and parents, if any.
The sample consists of 554 lateral roentgenografic cephalograms taken from 155 cleft families and 89 normal adults of the control group.
The means of all measurements were tested for significant statistical differences to distinguish the craniofacial structures in the experimental subjects from those in controls. Facial shapes of the parents were characterized by wide saddle angle and higher lower facial height with a clock-wise rotation of chin point which were analogous to those of individuals with cleft lip and palate. Then, from another point of view, the family likeness was examined by the cluster analysis. These data indicate that the morphological consistence as for craniofacial structures in the family is approximately 30 %.
This study was carried out under the ISM Cooperative Research Program (88-ISM. CRP-76).

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In order to find the causes of velo-pharyngeal incompetency after palato-plasty in cleft lip and palate, we analyzed the postoperative form and function of the velo-pharyngeal space. The patients consisted of 25 unilateral cleft lip and palates,8 bilateral cleft lip and palates,8 hard and soft palate clefts, and 5 soft palate, clefts. Palato-plasty was carried out at the mean age of 1.7 year. At age of 4 to 5 years velo-pharyngeal function was evaluated by lateral X-ray films and speech therapists.
The results were as follows:
1. The rate of velo-pharyn g eal incompetency was highest in patients with hard and soft palate cleft (50%).
2. The vertical distance of the space was significantly larger in patients with hard and soft cleft than other patients.
3. The movement of the soft palate was significantly poor in patients with velo-pharyngeal incompetency.
In conclusion the main causes of velo-pharyngeal incompetency were poor movement of the soft palate and large vertical distance of the space. Therefore, the vertical distance of the space should be reduced by primary palato-plasty especially in patients with hard and soft palate cleft.

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A case of cleft lip and palate associated with chromosomal abnormality (13q-syndrome) and fetal alcohol syndrome was presented.
A girl with multiple malformations and a history of prenatal exposure to ethanol was born to a 34-year-old mother after a pregnancy of 29 weeks. The patient's major clinical manifestations included pre-and post-natal growth retardation, mental retardation, cleft lip and palate, ptosis of the eyelids, short palpebral fissures, low-set malformed ears, short neck, small hands, single flexion crease of the fifth fingers, labial hypoplasia, and an anteriorly displaced anus.
A chromosomal abnormality,46, XX, del (13) (q 21.2→q 32) was present. The 13q-chromosome, maternal in origin, could be the consequence of ethanol exposure during maternal meiosis.
Her cleft lip and cleft palate were repaired at age 10 months and 4 years 1 month, respectively.

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In order to evaluate the palatal mucosal flap method for primary cleft palate repair, speech, velopharyngeal function and fistulas following such repairs were investigated. Eighty nine patients were operated on by this method at our institute from June 1974 to December 1984. They consisted of 14 children with bilateral cleft lip and palate,53 with unilateral cleft lip and palate and 22 with only cleft palate. The operations were performed patients aged between 14 and 23 months by plastic surgeons. Experienced speech therapists and an otorhinolaryngologist evaluated their speech, velopharyngeal function and fistulas. The evaluation was done before secondary operations and speech therapy. The results were as follows: 42 cases (47.2) attained normal speech. Hyper n asality was observed in 18 cases (20.2 %) and articulation disorders were in 42 cases (47.2 %). Among articulation disorders, palatalized articulation was most (24 cases), followed by glottal stop or lateral articulation (11 cases each). Articulation disorders occured more frequently in severer type of cleft. The occurrence of palatalized articulation was correlated with cleft type.
Seventy five cases (84.3 %) attained good velopharyngeal function. Eight cases (9.0 %)were border line and 6 cases (6.7 %) needed secondary operations due to insufficient velopharyngeal function. Even with good velopharyngeal function,41 % showed articulation disorders.
Fistulas were observed in 22 cases (24.7 %) and 10 cases (11.2 %) needed fistulectomy. No correlation was found between the incidence of fistulas and articulation disorders.
Comparing these findings with the results of usual push-back operation (mucoperiosteal method), no significant differences were found. We recommend the palatal mucosal flap method not only because of good maxillary growth but also speech results.

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The numerical abnormality, congenital missing teeth, supernumerary teeth, and fused teeth, were observed in permanent dentition of 417 cleft palate patients compared with 330 non-cleft adolescent from seventeen to nineteen years of age, based on orthopantomograph and dental cast. Third molar were excluded as to subjects in this study.
The numerical abnormalities were found in the patients with either cleft lip (CL), cleft lip and alveolus (CLA), cleft lip and palate (CLP), or isolated cleft palate (CP) in much higher frequency as compared with that in non-cleft group. Among them, congenital missing teeth was found in the highest frequency, followed by supernumerary teeth, and fused teeth. The frequency was: 55.6 % in CL,51.7 % in CLA,77.9 % in CLP,31.6% in CP, all of which were much higher than that of non-cleft group (7.6 %). The frequency of congenital missing teeth appeared to increase correlated to the extent of cleft region. In the other hand, supernumerary teeth were found to occur only in two cleft types; the frequency of occurence was 14.6 % in CLA and 8.4 % in CLP, both of which were higher than those in non-cleft type. Although fused teeth were also observed only in the two cleft types, there was no difference in frequency between cleft and non-cleft groups. As far as tested in this study, no sexual difference was found in numerical abnormalities of permanent dentition.
These results made clear that both congenital missing teeth and supernumerary teeth occur much more frequently than those in non-cleft subjects and suggest the possibility that different factors may be involved in the pathogenesis of these two numerical abnormalities, both frequently appeared to he associated with cleft palate.

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The purposes of this study were to measure the dental arch of non-cleft and cleft patients and to evaluate the possible effects of maxillary lateral expansion on the palatal volume of cleft lip and palate patients.
The materials consisted of plaster models obtained from 9 non-cleft patients (non-cleft group) and 9 unilateral cleft lip and palate patients (cleft group), whose maxillary arches expanded laterally at Department of Orthodontics, Osaka Dental University Hospital. In addition to the cast model meansurements, palatal volume was measured by means of a newly developed "palatal molding method" using a clay cast on the palatal vault.
The results obtained were as follows:
1. The cleft group had a narrow inter-canine width but molar width was the same as that of the non-cleft group. After maxillary lateral exansion treatment, arch width increment at canine area was more than of molar width in cleft group. There was no difference in molar width increment between the two groups.
2. Palatal volume of cleft group (3.20 cc) was smaller than that of non-cleft group (6.12 cc). After treatment, cleft group palatal volume increment was more than that in non-cleft group. The palatal volume increased in the same ratio as canine width. There was no correlation of increment ratio between palatal volume and molar width.
3. Palatal volume of the adulthood increased after expansion treatment. There was no relationship between palatal volume increment and patient age.
4. Cleft palate patients had a shallower palatal vault than non cleft patients with narrow dental arch. That is one of the general characteristics of a cleft palate.
5. Palatal depth index (palatal vault height/molar width) revealed a flatter palatal vault in the cleft group. The index decreased in both groups after lateral expansion treatment.

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Clinico-statistical analyses were carried out on 996 patients (525 males and 471 females) with cleft lip and/or palate in the Orthodontic Clinic, Kyushu University Dental Hospital, during about 19 years from August 1970 to December 1988.
The findings were as follows:
1. The peak of the age of the patients at first visit to our Orthodontic clinic was 3 years old.
2. Distributions of cleft type were; cleft lip (CL) 6.0 %, cleft lip and jaw (CUJ) 17.4 %, cleft lip and palate (CLP) 59.8 %, isolated cleft palate (CP) 16.8 %.
3. Distributions of cleft site were; bilateral cleft 18.6 %, left side cleft 53.4 %, right side cleft 27.6 %.
4. Sex ratio (male: female) were; CL 1.4: 1, CLJ 1: 1, CLP 1.5: 1, CP 1: 2.4.
5. The occurence of the premature delivery (36 weeks and less) was significantly higher than of Japanese general subjects (p<0.05). There was no significant difference in the means of birth weight, birth height and mother's age.
6. The most frequent number of siblings was two (55.1 %). The rate of the first and second children in the birth rank was 85.8 % and the rate of the last child was 66.9 %.
7. Arch form in unilateral cleft lip and palate were; Overlap of alveolar processes 6.8 % Butt-joint contact between alveolar processes 81.4 % No contact between alveolar processes 11.8 %
8. The prevalence of cross-bite was 84.6 % in all patients,87.9 % in unilateral cleft lip and palate patients,94.0 % in bilateral cleft lip and palate paatients.
9. The rate of patients who rejected the orthodontic treatment were; 23.3 % in CL,16.7 % in CLJ,11.8 % in CLP,21.6 % in CP patients.

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