Cleft lip and cleft palate are the most common of all facial malformations, occurring in all racial and ethnic groups. Japanese is one of the population with highest incidences of cleft lip and cleft palate, although the reason is unknown.
Recent concepts on the embryogenesis and etiology of these malformations have been reviewed. The etiology is heterogeneous, so the embryogenesis is complicated. It has been suggested that a cleft lip being a cleft of the primary palate may result from a failure of the fusion between the inferior parts of the medial and lateral nasal processes, while a cleft palate being a cleft of the secondary palate may be caused by a failure of the contact between two palatal shelves in general.
Developments of cleft lip and cleft palate except their syndrome groups have been explained by a multifactorial/threshold model. The result of a family study on Japanese cleft lips with or without cleft palate and cleft palate alone well agreed with the prediction of multifactorial inheritance and the segregation analysis of their families showed that 84.6 % of sporadic cleft lip cases with or without cleft palate could not been explained by a simple recessive inheritance mode.
A large number of environmental factors induce both cleft lip and cleft palate in experimental animals and maternal infection of rubella virus and use of steroids and antiepileptic drugs should be said attention in human beings.

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The morphological condition of the lip and columella is very important for cleft lip plasty, especially valuable for the bilateral cleft lip plasty. The lateral face of 536 normal Japanese children aged from 3 to 6 years were measured on a picture taken from the same distance on the median and Frankfort horizontal planes using a head fixation and photo apparatus.
The results obtained were as follows:
1) The measurements obtained varied among individuals but no significant difference was observed between the sexes, and the growth during the age seriod from 3 to 6 years was minimal and no significant difference was observed except Ls'-Ni' indicative of the projection degree of the upper lip.
2) Accordingly all the mean values obtained in the children aged from 3 to 6 years could be used as a standard model of normal lip and columella forms.
3) Among the mean values of various determination items, the following were especially useful for bilateral cleft lip plasty: (1) On Distances; Ni-Ls 12.0±1.7 mm, Ls-Li 15.5±2.7 mm, Na'-Ni' 11.2±1.9 mm, Ls'-Li' 6.4±3.0 mm, Na-mF 10.1±1.1 mm, Ls-mF 3.3±1.0 mm, Ls'-Ni' (only this value showed a significant difference chronologically. ). (2) On Angles, ∠ F line-H line 73.5±4.7°, ∠ Z F line-(Ni-Slm) 6.1 ±2.4°, Angle of the face and nose 20.9±2.5°, ∠ Ni-M-Ls 3.6±1.8°, ∠ Ni-M-Slm 7.4±2.3°, ∠ mF line-H line 86.0±4.6°, Angle of the upper lip 15.1±8.2°, ∠ Ls-M-Li 6.5±2.1°, Angle of the lip and columella 99.6±10.6°, Angle of the nose tip 93.1 ±4.4°.
Annotation:
Ni: Nasal columella base
Ls: Medion point of the upper vermillion border
Li. Medion point of the lower vermillion border
Na': Nose tip projected on the Frankfort horizontal plane
Ni': Nasal columella base projected on the Frankfort horizontal plane
Ls': Median point of the upper vermillion border projected on the Frankfort horizontal plane
Li': Median point of the lower vermillion border projected on the Frankfort horizontal plane
Na: Nose tip
mF line: Line from the median point of both internal eye angles to the nasal columella base (Ni-M)
F line: Line from the median point of both internal eye angles to the median point of mentolabial sulcus (M-Pog)
H line: Frankfort horizontal plane (Or-Tr)
Slm: Mentolabial sulcus
M: Median point of both internal eye angles
Angle of the face and nose: Angle between mF line and M-Na line (∠ Ni-M-Na)
Angle of the upper lip: Angle between mF line and Ni-Ls line
Angle of the lip and columella: Angle of the upper lip to the nasal columella
Angle of the nose tip: Angle of the nasal columella to the dorsum

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A malocclusion having a history of surgical repair for cleft lip and palate shows mandibular prognathism caused by maxillary deficiency in many cases, and also has more complicated problems of congenital missing and/or anomaly of teeth.
It is, therefore, critical to know the growth and developmental degree of the mandibule, which sometime overdevelops in comparison with the underdeveloped maxilla, when treatment is proceeded.
To investigate how the mandibule grows and develops in cleft lip and palate cases, a fusing time between epiphysis and diaphysis of the distal phalanx of the first digit was used as a standard. Materials used were serial cephalograms of 10 male and 10 female cleft lip and palate patients who had surgical repairs and of 14 males and 18 females having other malocclusions as controls.
Results:
1. A chronological age to reach a fusion of the distal phalanx of the first digit was 14 years and 8 months in males, and 12 years and 5 months in females for the cleft lip and palate group, and 14 years and 10 months, and 12 years and 10 months for male and female controls respectively.
There was almost no difference between the groups, while females were 2 years ahead of males as to the difference between the sexes.
2. As to the growth of mandibular length before and after fusion of the distal phalanx of the first digit, a large growth before fusion and a small growth after fusion were revealed in almost all cases examined irrespective of different sexes and groups, although some individual difference was observed.
3. The mandibular length at the fusion of the distal phalanx of the first digit was 119.6 mm in males, and 110.1 mm in females of the cleft lip and palate group, while it was 124.3 mm in males, and 115.2 mm in females of the control group, indicating that the length in the cleft lip and palate group was smaller than that in the control group for both sexes.

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The chief symptoms of spinocerebellar degeneration (S. C. D. ) are disorders of upper or lower limb movement and of speech. Though some reports on its dysarthrie have been presented, there are few detailed studies on its velopharyngeal closure function. Thus, we investigated the velopharyngeal function in S. C. D. patients using a nasopharyngeal fiberscope to see the nasopharyngeal movement directly.
The subjects were 10 patients who were diagnosed as S. C. D. at the First Department of Internal Medicine, Faculty of Medicine, Kumamoto University or its related hospitals. The age of patients ranged from 24 to 76 years. Velopharyngeal function was examined by intelligibility rating aerodynamic and nasopharyngeal fiberscopic examinations.
In the intelligibility rating examination, the monosyllable was 88.4 % and the nonsense threesyllable was 74.5 % on the average. Air leakage from the nose was observed in 2 out of 7 cases in the aerodynamic examination. In the nasopharyngeal fiberscopic examination,3 cases were classified into 0 type,1 was I c type,2 were ITI type and 1 was IV type. But 2 cases showed on incomplate closure only at blowing. In another 1 case, a complete closure was seen at some consonants and vowels. So these three cases didn't belong to Yamaoka's classification.
From these results, it was obvious that the degree of velopharyngeal closure function is variable in S. C. D.. It was also suggested that the progress of disfunction is related to the pattern of disease in S. C. D.. In other words, to examine the velopharyngeal closure dysfunction seems useful for deciding the pattern of disease or grasping the state of progress in S. C. D. patients.

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This study was performed to identify various factors influencing the incidence of cleft lip and palate in aged (more than 280 days) A/J strain mice. These factors included estrous cycle, maternal weight, implantation site, prenatal mortality, and litter size.
1. The incidence of cleft palate with cleft lip was 5.5±11.0 % and that of cleft palate without cleft lip was 1.8±7.5 %.
2. The reduction of cleft lip and palate was significantly related to the prolonged estrous cycle.
3. The results were discussed in relation to the reduction of cleft lip and palate with estradiol in A/J strain mice.

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We previously found a positive correlation between the prolonged estrous cycle due to agihg and the incidence of cleft lip/palate in A/J mice. It was hypothesized that this correlation may be ascribed to the metabolism of estradiol. We thus carried out the following experiment:
A/J strain mice were used. Females aged 70 days were mated overnight with males, and the day then a vaginal plug was observed was taken as gestation day 0. Pregnant females were injected subcutaneously with 5,12.5,25μg/kg of estradiol benzoate on day 8,9, or 10 of gestation.
All pregnant females were sacrificed on gestation day 18. The numbers of implantation site, resorption, and dead fetus were recorded. Fetuses were removed and examined for gross anomalies. The incidence of cleft lip with cleft palate and that without cleft palate were analysed by Mann-Whitney's U test.
As a result, the incidence of cleft lip with or without cleft palate was significantly reduced on days 8 and 9 of gestation, but their fetal mortality rates showed no significantly change. So, our results suggested that estradiol has a preventive effect on cleft lip and/or palate in A/J mice.

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A statistical survey on the current situation of a demand for orthodontic treatment, morphology of the maxillary alveolar arch and the cross biting condition was carried out on 532 cleft lip and/or palate patients (288 males and 244 females) who decided to receive their orthodontic treatment in the Orthodontic Clinic of Hiroshima University Dental Hospital from April 1968 to March 1989.
The results were as follows:
1. About 30 new patients with cleft had come to receive their orthodontic treatment in our clinic every year.
2. Half of the patients was from 6 to 8 years old at their first visit to our clinic.
3. The percentage of cleft patients was 10.7 % of all orthodontic patients in our clinic.
4. The ratio of male patients was larger than the female's.
5.77.3 % of the cleft patients lived in Hiroshima Prefecture, and half of them lived in Hiroshima City.
6.50 % of the introduced patients were from Hiroshima University Medical or Dental Hospital. And 50 % of all patients were introduced from the department of oral surgery or dentistry of a university or public hospital or private dental clinic.
7.50 % of the cleft patients had received their initial repair surgery at Hiroshima University Medical or Dental Hospital. And 45 % of all cleft patients had received their initial repair surgery at the department of otorhinology of a university or public hospital.
8. The incidence of each cleft type was as follows:
cleft lip (CL) 1.1 %, cleft lip and alveolus (CLA) 15.7 %, cleft lip and palate (CLP) 70.8 %, cleft palate (CP) 12.1 %, midline cleft 0.4 %.
9. The incidence of cleft site was as follows:
The left side cleft was most frequent and occupied 65.1 % of CLA patients and 49.9 % of CLP patients. The right side cleft occupied 30.1 % of CLA patients and 26.7 % of CLP patients, and the bilateral cleft occupied 4.8 % of CLA patients and 23.5 % of CLP patients.
10. The incidence of maxillary alveolar arch form was as follows:
1) In unilateral CLA patients, the butt-joint type amounted to 90.7 %.
2) In unilateral CLP patients, the butt-joint type amounted to 68.1 % and the collapsed type to 22.1 %.
3) In bilateral CLP patients, the butt-joint type amounted to 32.1 % and the protrusion type of premaxilla to 48.1 %.
11. The incidence of cross bite was 97.3 % of unilateral CLP patients,93.8 % of bilateral CLP patients and 91.4 % of CP patients.

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