The purpose of the present study was to test the hypothesis that meticulous resection of the vomer during cleft palate surgery may cause subsequent growth retardation in the maxillofacial complex. Fourty-five purebred normal beagle pups had clefts created surgically in the palate on their 21 st postnatal day. The cleft was repaired using medial advancement of palatal flaps with differing portions of vomer resection at the 42 nd postnatal day.
Pups were assigned to one of 5 groups as follows: Control group; unopera t ed controls, CPR group; repair of the cleft without any surgical intervention to the vomer, AVR group; repair of the cleft with resection of anterior portion of the vomer, PVR group; repair of the cleft with resection of posterior portion of the vomer, EVR group; repair of the cleft with entire vomer resection.
Longitudinal growth records included roentgen cephalograms from the 3 rd postnatal week to maturity, at the 34 th postnatal week.
Results revealed development of an anterior incisor crossbite relationship and maxillary growth retardation in all pups with vomer resection. The results support the hypothesis that the resection of the vomer during cleft palate repair impairs antero-posterior growth of the maxilla.

View full abstract

Cleft lip and/or palate is one of the most common congenital anomaries. In order to examine whether extrapolation is possible between spontaneous cleft lip/or palate mice and epidemiological cleft patterns in human, a comparative study was performed.
We used two spontaneous cleft lip and/or palate mouse strains, CL/Fr mice (39), and A/J mice (65), and ddY mice (11) as a control, which were all bred in our laboratory.
The embryos obtained by mating counted 242 for CL/Fr,536 for A/J and 111 for ddY mice.
Results: 1. The incidence of cleft lip and/or palate is 12.0 % in A/J mice, and 27.3 % in CL/Fr mice.
2. About a bilateral cleft lip pattern, the incidence is 15.4 % in human,21.5 % in A/J mice, and 69.8 % in CL/Fr mice. Therefore, the bilateral cleft lip pattern was observed at a higher incidence in the mice.
3. No incomplete cleft type was found in any mice enrolled in this study, but less variation of the cleft pattern was evident in the mice than in human.
4. A complete cleft pattern is observed in all A/J and CL/Fr mice, and 54.9 % in human. The incidence of complete cleft was higher than that of incomplete cleft in both mice and human.
5. The incidence of left side cleft lip is 9.2 % in A/J mice,21.2 % in CL/Fr mice and 41.3 % in human. Therefore, a cleft lip seems to appear more frequenthy on the left side than on the right side in both mice and human.

View full abstract

Veloph a ryngeal space measurements of 8 points in width, length or distance were performed in 80 patients with cleft lip and/or palate immediately before and after the palatoplastic operation under general anesthesia. The movements of soft palate and both sides of lateral pharyngeal walls were also studied preoperatively. Three years after the operation, velopharyngeal competence of these patients were studied at the age of 5 to 6 years and the relation between the preoperative velopharyngeal conditions and 3 year-postoperative velopharyngeal functions was investigated.
At the age of 5 to 6 years,70 of the 80 patients had competent velopharyngeal functions and 10 patients showed incompetence. Preoperative measurements of the pharyngeal depth were most significantly related with the postoperative velopharyngeal competence. Among the 10 cases with velopharyngeal incompetence which included those of slight insufficiency, one showed 16 mm distance and 7 showed 11-15 mm distance. The other two showed 10mm but, in these cases, the width between both sides of uvula was greater preoperatively.
Conclusively, the cases which had more than 11 mm of velopharyngeal distance and retarded movements of soft palate and pharyngeal walls showed an inferior prognosis of velopharyngeal functions at 3 years postoperatively.

View full abstract

In the presence of cleft, the teeth a tooth adjacent to the cleft portion inclines toward the fissure and its small segment takes a lingually stenosed arch form. Such a complicated maxillary form probably affects the mandible and limits the mandibular movement itself. Thus, in this report, we examined its relationship to the mandibullar movement through a functional research.
The subjects are 18 patients with unilateral cleft lip and palate at dental age II C-IIIC stage, who were examined at the Department of Orthodontics, Ohu University.
Cephalometric radiogram (hereinafter referred to Cephalo), temporomandibular joint tomograms (Secto) and electromyograms (EMG), which have been taken at the first examination, were used as the analysis Cephalo and Secto were measured for 12 and 1 angular items and 12 and 8 distance items, respectively. For EMG, frequencies at tapping and cleanching were analyzed. The following results were obtained:
1. The analysis of Cephalo revealed a maxillary under growth and a lingual inclination of maxillomandibular anterior teeth.
2. The distance analysis of Secto revealed a protrusive position of the condylar on the cleft side compared with the non-cleft side. The angular analysis of Secto revealed no significant difference between the cleft and non-cleft sides.
3. The analysis of EMG reveald a prolonged silent period on the cleft side for both masseter and temporal muscles compared with the non-cleft side, but no significant difference in the peak frequency was noted between both sides.
Besides, each phase was long, and a timelag of masticatory cycle was noted.
The above results suggest that the maxillary characteristic form observed in the subjects with unilateral cleft lip and palate has a functional influence on the kinetics and the muscular activity of the condyle on the cleft side and and that the maxillary cleft side limits the mandibular movement.

View full abstract

The purpose of this study is to investigate the growth and development, dimension, chronologic changes and the features of the cranial base in patient with cleft lip and palate.
The subjects consisted of 19 males and 12 females having unilateral cleft lip and palate, whose age averaged 7 years and 7 months. The control group consisted of 17 males and 18 females with skeletal reversed occlusion and the mean age of 7 years and 10 months.
Standardized lateral cephalometric radiographs were used which had been taken at the first medical examination and three years thereafter. The three linear dimensions (S-N, S-Ba, N-Ba) and craniobasal angle (N-S-Ba) were measured. The measurements were analysed statistically, and the coefficient of correlation was calculated.
The results were as follows:
1. There was no significant difference in the cranial base dimensions (S-N, S-Ba, N-Ba) between the subjects and the controls.
2. The amount changed in the craniobasal angle was larger in the subjects as compared with the controls, indicating a narrowing trend of the craniobasal angle with increased ages in patiants with cleft lip and palate.
3. With regard to the correlation between the growth amount of the basicranial axis and the anterior or posterior cranial base, it was suggested that the anterior cranial base mainly participate in the growth amount of the basicranial axis in cleft lip and palate, while the posterior cranial base, mainly participate in the growth amount of the basicranial axis in skeletal reversed occlusion.

View full abstract

A clinico-statistical review of 462 patients with cleft lip alveolus and palate who had recieved a primary operation during the past 10 years from January 1978 to December 1987 was carried out.
The following findings were noted.
1. The geographic distribution of the patients enrolled in this review was 41.2 % from Okayama prefecture and 27.3 % from Hiroshima prefecture.
2. The cleft morphology was classified as follows: cleft lip in 72 cases (15.6 %), cleft lip alveolus in 98 cases (21.1 %), cleft lip and palate in 6 cases (1.3 %), cleft lip alveolus and palate in 186 cases (40.3 %), cleft palate in 100 cases (21.6 %).
3. All types of clefts were more frequently observed in males than in females.
4. Unilateral clefts were significantly predominant as compared with bilateral ones, and the incidence of left side cleft was significantly higher than that of the right side.
5. A familial disposition was found in 39 of the 462 families examined. (8.4%).
6. The incidence of cleft-associated malformations was 16.7 %, with a high percentage for cleft palate alone. These malformations were most commonly associated with abnormalities of the limbs; e. g. Pierre-Robin syndrome and auricular malformation.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract