[in Japanese]

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Serial dental casts on 154 cleft subjects consising of 13 cleft lip (CL),24 cleft lip and alveolus (CLA),23 bilateral cleft lip and palate (b-CLP),58 unilateral cleft lip and palate (u-CLP), and 36 cleft palate (CP) were reviewed to study changes in the dental arch dimensions. Dental casts were taken after cheiloplasty and/or palatoplasty until the beginning of orthodontic treatments. Changes in the dental arch widths were different among each cleft type; CL, CLA, u-CLP, b-CLP, and CP. A majority of the CL and CLA cases showed increases in dental arch widths, while the dental arch widths decreased in 20-40 % of CP cases,60-70% of b-CLP, and 40-55 % of u-CLP. Dental arch lengths showed no special tendency for each specific cleft type in subjects with cleft lip.
The continuity of the maxillary complex is an important factor for determining the dental arch form. In CLP subjects, there was a higher frequency in the reduction of the maxillary primary inter-1 st molar width than in the inter-2 nd molar or inter-canine widths. This result suggests an impediment caused by the palatoplasty.
In the post-operative course of more than two years, some cases showed a reduction of dental arch widths. The increasing or the decreasing change was larger in subjects between four and eight years of age, and especially between the ages of six and eight years. Although the evaluation based on the average changes of longitudinal data may show a catch-up growth pattern after an operation, an analysis of each individual shows an increase or a decrease, sometimes a slow and sometimes a rapid one.

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Fifty-two patients with cleft palate who underwent the palatoplasty without elevation of the mucoperiosteal flap on the cleft side, were investigated on velopharyngeal function and articulation.
The subjects included thirteen children with unilateral cleft lip and palate, ten with ha rd and soft palate, and twenty-nine with soft palate only.
Those operations were performed betwe en the ages of 12 and 36 months after birth by several plastic surgeons.
The velopharyngeal function was measured acoustically, aerodynamically, and studied by fiberoptic and videoradiographic observation, to be graded as competence, slight incompetence, and incompetence.
The results were: 48 patients (92.4%) with competence,2 (3.8%) with slight incompetenc e, and 2 (3.8%) with incompetence. No significant asymmetrical movements of the velum were observed in any patient under fiberoptic observation of the nasopharynx.
Articulation disorders were found in 10 cases of the 52 patients (19.1%). Immature articulation was recognized in 5 patients (9.6%), palatalized articulation in 2 (3.8%), omission in 2 (3.8%), and faulty laryngeal articulation in one (1.9%).

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Twenty-nine patients with non-treated submucous cleft palate referred to our clinic were evaluated by intraoral and instrumental examination, speech analysis, videonasoendoscopy, cephalography and videofluoroscopy.
1) Spee ch analysis Severe hyp ernasality was found in 55.2% of the cases. Six of the 29 patients had adequate velopharyngeal function. Articulation disorders were found in 72.4% of cases, with glottal stop the most frequent, in nine cases.
2) Videonasoendo scopy The contour of the velopharyngeal portal at rest identified by nasoendoscopy was classified as notch, pentagonal, or rectangular. Thirteen patients showed a notch-like contour and 12 showed a pentagonal contour. The remaining four patients showed a rectangular contour. Velopharyngeal closure pattern was also classified as coronal, mixed, circular or sagittal. A coronal closure pattern was observed in 14 individuals, and 11 patients exhibited a mixed closure pattern. Four of the 29 patients showed a circular pattern. None showed a sagittal closure pattern. There was no significant relationship between velopharyngeal closure pattern and velopharyngeal insufficiency.
3) Cephalography The soft palate to pharynx ratio ranged from 0.71 to 1.23. The average ratio was nearly 1.0 in each age group. The soft palate was generally thinner than in normal individuals.
4) Videofluoroscopy The contour of the lateral pharyngeal wall during /i: / phonation was classified into four categories: broad shelf, narrow shelf, vertical or irregular. The degree of lateral pharyngeal wall movement changed during /a:/, /i:/, /pa/, /∫i:/ and /ma/ phonation. The contour of the lateral pharyngeal wall during phonation was found to be generally constant except with /ma/.

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In order to elucidate the pathogenesis of cleft palate induced by vincristine, a single intraperitoneal injection of 0.2mg/kg vincristine was performed in Wistar rats on the 8th day and 12 hours of gestation and fetuses were extracted the period from the 14th day and 18hours to the 19th day and 0 hour of gestations at 6-hour intervals for observation by scanning electron and light microscopy, the results of which are described as follows.
1. Cleft palate were observed in 45.5% of the fetuses during the period from the 16th day and 12hours to the 19th day and 0 hour. Mainly as median facial clefts caused these fetuses, so congenital anomalies especially celebral-facial anomalies were observed in the other fetuses.
2. The cleft palate fetuses in dosage group demonstrated severe hypoplasi a of palatal shelves, disturbance of shelf elevation and shelf fusion.
3. The hypoplasia of mandible was observed while the palatal shelves of vincristine-treated fetuses were in the vertical position. The palatal free epithelial cells of cleft palate fetuses induced by vincristine were disturbed differentiation.
4. The hypoplasia or a plasia of sphenoethmoidal recess and Jacobson's organ were observed in vincristinetreated fetuses.
5. All of the alterations may contribute to the pathogenesis of cleft palate induced by vincristine. Especially these fetuses may be derived from the hypoplasia or aplasia of median facial region and naso-maxillary hypoplasia.

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This study was undertaken to determine whether the administration of vitamins, especially folinic acid (FA) prevent the spontaneous CL/CP or not and to clarify its mechanism. FA was administered to pregnant A/J mice by intraperitoneal injection at 11: 00 A. M. on day 10 of gestation (Plug day = 0) at various doses (3,10,20,30,100, and 300 mg/kg body weight). All pregnant animals were sacrificed on day 18 or 19 of gestation. The number of resorptions and live or dead fetuses were noted. Each live fetus was examined for the presence of CL/CP.
Consequently, cell death of primary palate was investigated using supra vital Nile blue sulphate (NBS)staining on days 10,11, and 12 of gestation.
1. The number of intrauterine m ortality did not increase.
2. The mean incidence of fetus with CLP (especia l ly UCLP) decreased by administering 10 to 30mg/kg body weight of FA to dams on day 10 of gestation.
3. The mean incidence of fetus with CP increased by administering 10 to 30 mg/kg body weight of FA to dams on day 10 of gestation.
4. The mean incidence of fetus with CL/CP did not change.
5. The development stage of the face, the degree and extent of uptaking of NBS in primary palate did not alter between the embryos from a litter that received a dose of FA of 10 mg/kg body weight on day 10 of gestation and from the control litter.
6. Embryos with a potential CL could be found at the crescent stage by asymmetric nasal pit. Embryos with a definite CL could be found at the comma stage by failure of fusion between medial nasal process (MNP) and lateral nasal process (LNP) because MNP were more prominent, and more medially placed.
7. Cell death could be observed in the presumptive fusion zone of normal embryos, and it could be kept in the same areas of the CL fetuses.
8. Administration of FA prevents CL and alter CLP to CP only.
9. The mechanism of prevention of CLP is considered to be FA which does not alter the potentiality of fusion in the presumptive fusion zone, but alters the development of the nasal processes.
10. It is supposed that CP is not isolated congenital malformation from CLP in A/J mice, and the degree of cleft could be due to environmental factors.

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In our clinic, McNeil type resin plate was used on cleft lip and palate patients as a presurgical orthopedic treatment from 1962 to 1969. It was commenced in early infancy and used until cheiloplasty.
Long term results of ten patients, who were thus treated and could be followed up until becoming adult, were compared with those of the comparable control patients without McNeil plate treatment, using maxillary casts and cephalometric head films taken when grown-up.
We couldn't find any evidence that McNeil type plates brought good effects on the maxillary growth.

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For the evaluation of respiratory function following pharyngeal flap operation, arterial SaO₂ was monitored with the use of pulse oxymetry. All of the 6 subjects with snoring during sleep after surgery were selected randomly, and were followed by arterial SaO₂ during sleep from 0.00 a. m. to 5 a. m. for the 1st to 12th postoperation 10 days.
The results obtained were as follows,
1. Slightly undulated changes of the mean arterial SaO₂ to the normal lower amount (SaO₂ 94 %)were seen in four out of six patients during sleep in the period from the 2nd to 6th postoperation days.
2. All six patients maintained SaO₂ within the normal range during sleep following the 8th postoperation day.
These fi ndings may suggest that the pharyngeal flap operation, based on our method, may not cause obstructive sleep apnea, however, the monitoring of respiration for a week after operation may be recommended.

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