This study investigatedt he presence and pattern of artic ulation disorders, velopharyngeal insufficienc(yV PI), fistulas, a nd abnormalitieso f occlusiona nd dental arch in 221 cleft p alate children who received the primary palatoplasty under the age of one and a half years. These factors were also analyzed focusing on the effect on palatalized articulation and lateral articulation. All subjects had been systematically treated by the Showa University Cleft Palate Team since 1980.
Data was obtained in the follow-up sessions, which were periodically provided, until the the subjects became five years old. No speech therapy was given before data collection. The results are summarized as follows:
1. Of 2 2 1 children,101 (46 %) showed articulation disorders.
2. Thirty-three subjects had mild VPI and two s u bjects demonstrated moderate to severe VPI. Twenty-six of them (74 %) showed artioulation disorders, and glottal stop was the most common type of their misarticulations.
3. One hun dred and eighty-six subjects (84 %) attained good velophpryngeal function although 75 of them (40 %) showed articulation disorders. Many of these subjects demonstrated palatalized articulation (60%) and lateral articulation (33%).
4. Types of clefts seemed to affect the patterns of misarticulations. Palatalized articulation frequently occurred in children with bilateral cleft lip and palate, while lateral artioulation frequently occurred in children with unilateral cleft lip and palate.
5. Fistulas were observed in 85 su bjects (38 %). Size of the fistulas appeared to affect the patterns of their misarticulations. In the subjects with larger fistulas, palatalized articulation was most common (50 %).
6. Occlusions were examined by the cast models in 124 cases. Eighty-seven of them (70 %) had cross bites with both front teeth and molar and palatalized articulation (45 %) was more frequently seen in these children than lateral articulation (15 %).
7. Severe constricted dental arches were found i n 32 of the 124 cases (26 %) and palatalized articulation (63 %) was more common than lateral articulation (19 %).
The results indicated that primary etiological factor of the articulation disorders in the cleft palate children was VPI and there was a tendency for the children with competent velopharyngeal function to show palatalized articulation caused by the effect of maxillary deformity.

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The results of surgical orthodontict reatment for cleft lip and palate pati entsw ere evaluated retrospectively. Fifteen adult unilateral cleft lip and palate patients who received surgical orthodontic treatment and obtainedg ood occlusionw ere divided into two g roups: 1) 7 patientsw ho received m an. dibular sagittal splitting osteotomy only (mandibular group) and 2) 8 patients who received maxillary Le Fort I ostetomy and mandibular sagittal splitting osteotomy simultaneously (two -jaw group).
Morphological comparisons between these two groups were made by using lateral cephalogram s taken at the following four stages: at the beginning of orthodontic treatment, just before surgery, just after surgery, and at more than 8 months after surgery.
The results were as follows:
1) Skeletal maxillo-mandibula r disharmony was caused by the rertoposition of the ma xilla in the majority of the cases. This disharmony was greater in the two -jaw group than that in the mandibu lar group.
2) The amount of surgical repositioning and subsequent skeletal changes were also greater in the two-jaw group. The increased nasolabial angle were found in the two -jaw group during surgery.
3) Tendency of the maxillary postero-superior displacement coupled with mandibular antero -sup e rior displacement during postsurgical orthodontic treatment was markedly found in the two -jaw group. On the contrary, a specific displacement tendency was found in the mandibular group. The changes of over jet and over bite in this period were greater in the mandibular group than that in the two -jaw group.
4) Two-jaw surgery was chosen for cases needing much surgical repositioning, while mandibular sagittal splitting osteotomy only was selected for those needing slight surgical repositioning. For the case needing moderate repositioning, two-jaw surgery was selected in case of severe maxillary retrusion or remarkable skeletal maxillo-mandibular disharmony.

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We devised a palatal plate as an obtulator to cover the remaining cleft on the hard palate after primary veloplasty was performed on 10 children, between 18 and 24 months of age, with complete cleft lip and palate. The plate was held in position by resin between the teeth on the alveolar cleft. The purpose of this study was to evaluate the effect of the palatal plate on maxillary and speech development at 4 years of age.
The results were as follow s;
1. All children could easily wear the plate. The plate was first placed at the time of 2.1 years old on the average.
2. The in ter-maxillary occlusal relation was compared between the time of initially placing the plate and the age of 4. The intermaxillary occlusal relation between the upper and lower first incisal teeth was the same at 4 years of age in all cases. The relation between the upper and lower first deciduous molar teeth had not changed during the period either. These indicated that the palatal would not disturb maxillary developmant during the period.
3. The velopharyngeal function, at 4 years of age, was f ound normal in 80% and border in 20%, whereas the misarticulations were palatalized articulation in 50 %, lateral articulation in 40 %, and glottal stop in 30 %. Tentative removal of the palatal plate at 4 years of age definitely caused nasality, pharyngeal fricative, and glottal stop in three cases.
4. Therefore, the palatal plate, which h ad been placed after primary veloplasty, affected speech development without disturbing the maxillary growth in the chidren treated with two-stage palatal closure.

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The velocardiofacial( VCF) syndrome is well known for a syndrome characterizedb y cleft palate, characteristicf ace and cardiovasculara nomalies. The speech quality reported before has been proven to show hypernasality caused by the velopharyngeal incompetence for which pharyngeal flaps urgery is indicated. Somer eports, however, r epresentedt hat the tortuositya nd displacemento f internal carotid artery involved in cardiovasculara nomalies preventedp haryngeal flap surgery.
This report describes a new geometrical procedure for the preoperative ascertainment of the course of the internal carotid artery using frontal digital subtraction angiography (DSA) and lateral cephalography. This procedure of geometrical analysis and measurements with DSA and cephalogram was designed to relate the exact location of the internal carotid artery with anatomical landmarks required in pharyngeal flap surgery.
This procedure was applied to the case of an 11-year-old girl who had VCF syndrome associated with velopharyngeal incompetence for which pharyngeal flap surgery was required. Digital subtraction angiogram and cephalogram were employed preoperatively for the ascertainment of the tortuosity of the internal carotid artery. The geometrical analysis designed above revealed the left internal carotid artery was shifted to the right, and the most dislocated point of the artery was indentified to be 10 mm left of the midline of the posterior pharyngeal wall and 16 mm below the point of the intersection of the palatal plane and posterior pharyngeal wall. The analysis enabled the elevation of a superiorly based pharyngeal flap of adequate size without any complication, which resulted in successful pharyngeal flap surgery for the improvement of the velopharyngeal function. The result suggests that the procedure of geometrical analysis and measurements using DSA and cephalogram could be employed for the ascertainment of the exact location of the internal carotid artery prior to pharyngeal flap surgery.

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This report described one case in which obstructive sleep apnea syndrome(OSAS)immediately fo llowing pharyngeal flap operation at 4 years of age had improved substantially through longterm palata lift prosthesis(PLP) treatment by 10 years of age. Clinicael valuation using videoradingraphy and lateral cephalogram at 5 years of age revealed that the OSAS in the case was caused by the airtight contact of tongue dorsum and immobile soft patate, which was attributed to retropositioning mandible, less mobility of soft palate impeded by low shifted flap base, poor growth in vertical dimension of maxillae and adenoidal hypertrophy.
PLP was applied to dissolve the airtight contact by maintaining the velolingual space through the elevation of the soft palate. The patient did not shown respiratory distress for the first 4 years until 9years of age in a condition with PLP, but OSAS had persisted in a condition without PLP. However, pulse oxymetrical assessment at 10 years of age revealed that respiratory function in the case without the PLP became normal because of the decrease in resistance in the upper air way associated with the vertical and anterior growth in maxillae and mandible respectively, and the involution of adenoid.
These findings suggest that OSAS caused by pharyngeal flap operation at an early age can be well managed with PLP and that assessments including maxillofacial morphology as well as respiratory function should be continued until the age when the maxillofacial structures achieve enough growth and the involution of adenoidal tissue are recognized.

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A clinico-statistical investigation was carried out on 472 patients with cleft lip and palate who had undergone a primary operation at the Department of Oral Surgery, Faculty of Medicine, University of Ryukyus during the 15 year period from September,1973 to August,1988.
1. There were 264 males and 208 females, with a male to female ratio of 1.3:1.
2. Cleft morphology was classified as follows: cleft lip only and/or alveolus in 139 cases (29.4 %), cleft lip and palate and/or alveolus in 218 cases (46.2 %), and cleft palate only in 115 cases (24.4 %).
3. Unilateral cleft lip and/or alveolus and palate were seen in 263 cases, and bilateral condition in 94 cases, with a ratio of 2.8: 1. In the 263 cases, the ratio for affected side was illustrated as 1: 1.9(right: left).
4. It was found that 12.4 % of 451 patients had a birth weight of 2500 or less grams. It was also found that 3.0 % of 466 mothers were aged 40 or older at subject's birth.
5. Other congenital anomalies were found to be associated in 6 0 cases (13.0 %), congenital heart disease were seen in 23 cases (5.0 %).
6. Familial occurence was found in 123 of 455 families of the propositi (27.0 %).

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In order to grasp the parent-child relations hip for CLP in childhood. The SAS program was used, and the reliability of items and measures were approved by a computer. To find the relationship between parents and their children with cleft lip and palate, we compared the parents of CLP children with the parents of normal children, who were in lower elementary school, through a questionnaire method. The objects were both the parents with CLP children (170 persons) and those with normal children (320 persons). This questionnaire was composed of 144 new items (4 factors; 18 measures x 8 items) on the basis of the diagnosistic test for parent-child relationship (E. S. Schaefer).
Results: Parent's attitude about raisins CLP children.
1. They treated their children as if they were yownger. The had a strong tendency to fill in for children in all points, and it did not seen to stimulate independent and individual nature according to the ability of the children. They criticized all actions of the children and still more denied everything. None of them cautioned or corrected errors as far as the language of the children.
2. There was little correlation shown likewise. In conclusion: They have kind attitude for raising CLP children. A few of them disciplined their children for the purpose of learning basic social standards and rules. They failed to fulfill their most important responsibility that of control and protection. They had a disagreeable influence upon the development and personality of the children.

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