In order to elucidate the growth and development pattern of alveolar arch and palate by Zurich's system,3-dimensional measurement of alveolar arch and palate, and palate surface area measurement were performed by Moire Topography method and Huddart's technique using maxillary plaster model from the first examination (Phase I ) up to after hard palate closure (Phase V) in 17 patients of BCLP group and 55 patients of UCLP group, who had undergone the therapy of Zurich's system. The results were compared with the data obtained from 15 nomal infants as a control group, and the following findings were obtained.
1. The anterior, medial and posterior width of alveolar arch was larger in UCLP and BCLP groups in Phase I to IV than in the control group and a little lower in Phase V.
2. The longer diameter of the entire alveolar arch was at the highest in BCLP group in Phase I and II, and next followed the control group. In Phase III and after, the control group showed the highest value, and UCLP group exhibited the lowest value throughout the whole period.
3. The width of cleft was at the highest in posterior region of UCLP group and medial region of BCLP gruop in Phase I and at the lowest in anterior region of UCLP and BCLP groups.
4. The width of alveolar cleft decreased more in UCLP group than in BCLP group, while alveolar cleft was also present in Phase V.
5. Antero-posterior deviation of alveolar cleft margin and the distance from incisive papilla to hypothetical median line gradually descreased in UCLP and BCLP groups, and the left-to-right deviation of alveolar cleft margin of UCLP group also gradually decreased.
6. The height of palate in each region was larger in UCLP and BCLP groups of Phase I to III than in the control group.
7. Unlike the control group, the height of anterior palate of UCLP and BCLP groups gradually decreased.
8. The frontal palatal inclination angle in each region was at the highest in UCLP and BCLP groups in Phase I to III, while the value was higher in the control group than in UCLP and BCLP groups in Phase V.
9. The total palate surface area was at the highest in UCLP group in Phase I and II, and next followed BCLP group. In Phase TII and after, the control group showed the highest value, and next followed UCLP group.
10. The change of surface area of each segment decreased in the order of: large segment and small segment of UCLP group, lateral segment of BCLP group. It was at the lowest in premaxilla.
11. The surface area of cleft decreased more extensively in UCLP group than in BCLP group, while it was higher in BCLP group than in UCLP group throughout the entire period.
12. The above results suggest that the growth and development pattern of alveolar arch and palate in UCLP and BCLP groups is entirely different from that of the control group. However, the form of alveolar arch and palate in UCLP and BCLP groups considerably resembled that of the control group.

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This paper is intended for setting a standard for application of palatoplasty to the infant afflicted with cleft palate in addition to serious developmental delay, by analyzing the cases of this kind observed over the past 10 years. Eighteen cases were chosen as study samples, comprising those who were diagnosed as possessing multiple anomalies or abnormal chromosomes just after birth and those whose stabilization of heads delayed by more than 5 months and are diagnosed as psycho-motor-developmental delay before undergoing palato plasty.
The items studied are 1) how many weeks the infant stayed in the uterus,2) weight at birth,3) growth before operation 4) age at operation,5) weight at operation,6)velopharyngeal function,7) acquisition of speech,8) feeding function.
Based upon the results of the analyses mentioned above, it seem s possible to fix a standard for application of palatoplasty to the cleft palate infant with serious developmental delay in the following way.
1. The infant shou l d be in good physical condition.
2. Contacts with other departments such as pediatri c s and anesthesiology should be available, when necessary.
3. The infa n t's head should be stable, and his language development should be over 6 months.
4. The infant's babbling or utterance should be frequent.
When all fcur conditions are met, palatoplasty should be r ecommended for the infant of the age of 2 or 3, even though the infant weighs less than 10 kg, expecting the improvement of his feeding function and the facilitation of his babbling.
Conclusion, it seems necessary to offer mental assistance to t he family of the patient, and check his development and feeding function regularly.

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To quantitatively evaluate the acoustic characteristics of Japanese glottal stops (JGS), pronounciation of /ta/ and /ka/ in 10 normal subjects and 14 patients with cleft palates including congenital velophargnyeal incompetence and functional articulation disorders were analyzed by sound spectrography (SG) and microcomputer. The frequency and time domain of both target syllables obtained were compared with psycho-acoustical judgment by speech therapists. The conclusions were as follows:
1. SG analysis showed that voice onset time (VOT) in the pronunciation of patients with articulation disorders were observed to be shorter than those of normal subjects. Spectrogram pattern in 1/3 of the JGS samples showed irregular fills, which were recongized when producing the fricative consonants, following obliteration of formant components in vowels.
2. Computer acoustical analysis showed:
1) Spectral envelope score (SES), which quantitated consonant frequency characters in spectrum envelope, demonstrated that the number of samples with a value above 5 dB in the control group was 60 % during the normal articulation of /ta/. In the test group we observed 17∼37 % JGS of /ta/ and /ka/, as well as normal articulation of /ka/.
2) VOT of more than 20 msec in all normal articulations of /ka/ with an average time of 44.6 msec, whereas 23∼41 % in normal articulation of /ta/ and JGS of /ta/ and /ka/ demonstrated an average time of 17.2∼20.8 msec.3) (ΔF2-ΔF
3) which is the difference in the transient portion calculated by linear predictive coding (LPC) method that showed that more than 200 Hz were 63 % in normal articulation of /ta/, whereas 13∼19 % in JGS of /ta/ and /ka/ and normal articulation of /ka/.
3. Psycho-acoustical judgment evaluating both the degree of distortion and clarity of burst which are the characteristics of JGS had been statistically compared with the results of computer acoustical analysis by rank correlation coefficicient method.
The inverse correlationship between VOT and the psyco-acoustical judgment for the degree of distortion was demonstrated to be statistically significant.

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Itoh has reported a new operative technique for oro-nasal fistulas using ear cartilage (1990). We used this method with some modification and operated on six fistula cases. Using this modified method, we undermined the circumference of the fistula to make mucosal flaps as large as possible from the oral side. Then the mucosal flaps were turned over to the nasal side, and the cartilage was inserted into or put on the turned over mucosal flaps and fixed with absorbable suturing. The six fistula closed from three to six weeks after the operation.

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A clinico-statistical investigation was carried out on 1356 patients hospitalized in our clinic between 1973-1984 having cleft lip and/or cleft palate. Comparing with the previous report of Sanui (1962) surveying about 2519 clefts, the following results were obtained.
1. Distribution of cleft types was similar.
2. In cleft lip patients (CL), the sex ratio has differed, in which male patients have significantly increased from 46.4 % to 61.2 %.
3. The ratio of bilateral type of cleft lip with cleft palate (CLP) have become slightly higher.
4. The occurring sides were similar.
5. Complications of other abnormalities have increased in CLP and cleft palate (CP).
6. The rate of consanguineous marriage among parents of patients in this survey was similar to that of general population.
7. The recurrence rate of similar abnormalities among sibs of propositi has slightly increased in CP.
8. The mother's age at delivery was found in larger number to be at older than 35 years old in CLP, and at younger than 24 years and older than 35 years in CP.
9. Seasonal trend was observed with the peak in winter. The observation was obtained from the CL relative to general population. However, the seasonl effect was weak.

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