In an effort to clarify the relationship between the deciduous molar occlusion and the skeletal pattern improvement during orthodontic treatment, a total of 23 complete unilateral cleft lip and palate cases were studied. Lip repair was carried out at about 3 to 7 months of age and palatal closure with pushback procedure was accomplished at about 18 to 24 months of age. These patients were then divided into two groups according to the condition of deciduous molar occlusion at the beginning of orthodontic treatment from 7 to 9 years of age. One group of 14 patients (8 Males,6 Females) showed deciduous molar contact relationship and another group of 9 patients (5 Males,4 Females) showed no deciduous molar contact relationship, though with crossbite in each. All of these patients received active orthodontic treatment until 14 to 18 years of age. Lateral roentgen cephalograms and dental cast models were obtained from each of the patients longitudinally, and data analysis was made.
The results obtained were as follows:
1. There was little difference in the m axillary forward and downward growth inhibition between the groups with and without deciduous molar contact.
2. All of the cases preserved a stable perm anent molar relationship during active orthodontic treatment in the group with deciduous molar contact, and showed improvement in maxillo-mandibular relationship with mandibular growth of backward and downward or downward only.
3. Most of the cases in the group without deciduous molar contact did not show a stable permanent molar relationship nor improvement during active orthodontic treatment due to the mandibular growth of forward and downward, or downward only.
These results may suggest that a st able molar relationship during deciduous dentition contributes to the preservation of permanent dentition and that it also contributes to the effective mandibular growth depending upon the maxilla.

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[in Japanese]

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Since 1987, we have used Furlow's double opposing Z-plasty for repairs on 29 children at our hospital (Table 1). We investigated the characteristics of the palatopharyngeal morphology and speech results with Furlow's method, using the control group with pushback operation (Table 2). Our results clarified the following points:
1. The speech results with Furlow's method were the same as those for the control group (Table 3∼6)
2. The length of the hard palate in soft palate clefts was longer in subjects than in the control group.
3. The length of the soft palate in soft palate clefts was significantly shorter in subjects than in th e control group.
4. The soft palate was generally thicker than in the control group.
In our experience this procedure is suitable for the repair of soft palate clefts, and we have selected the patients for adaptation of this method.

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One of the most important aims of secondary bone grafting is to allow for the closure of the cleft defect and provide a more ideal dental arch form orthodontically without any prothesis.
This study evaluated the bone bridge formation in 24 patients with a total of 29 clefts three dimentionally using X ray computed tomography and investigated its relationship with the subsesuent orthodontical repositioning of teeth adjacent to the cleft into the grafted sites.
Results are as follows: 1) Satisfactory bone formation was found only in 6 patients (20%).2) 20 clefts (69%) showed insufficient bone formation, which might disturb the movement of the teeth or either side of the cleft. In many of these cases, the lack of bone formation was observed of the nasal and medial sides of the cleft.3) Continuous but very thin bone bridge was recognized in 3 clefts (10%), which made the orthodontic closure of the arch impossible.
In conclusion, this study demonstrate d two major points concerning the surgical procedure: 1) It is important to raise the cleft mucoperiosteal flap superiorly enough along the cleft wall and trim the surplus tissue to make the nasal floor flat, deep and wide.2) It is also important to fill the alveolar cleft completely with small chips of cancellous bone and marrow only.

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We performed primary plastic surgery on two unoperated cleft palate abults with speech disorders at the age of 24 and 47, and the patients showed improvement in speech to the level of daily conversation. The conversational intelligibility improved their oral communication, and was also effective in their personality factors like“ emotionally stability”. It is conceded that such improvement in speech is a result of adequate velopharyngeal closure function and effective speech therapy. The effective speech therapy could not be carried out without the preoperative speech therapy. The significance of preoperative speech therapy is now suggested.

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Statistical study was carried out on 338 patients with cleft lip and/or palate who were treated in the department of orthodontics, Osaka Dental University during the 10 years from April 1,1982 to March 31,1991. The following findings were obtained:
1. Cleft lip and/or palate patients accounted for 8.9% (338 cases) of all orthodontic patients (3,817 cases).
2.245 (72.4%) out of 338 cleft lip and /or palate patients lived in Osaka prefecture.
3. The patients consisted of 172 males and 166 females.
4. The age of patients at the first visit ranged from 2 to 33 years old and 75.1% of them were between 5 and 14 years old.
5.44.4% of the patients showed the developmental stage of IIIB.
6.55.0% of the patients were referred from family dentists.
7. The incidence of the type of cleft lip and/or palate was as follows: Unilateral cleft lip and palate; 190 cases (56.2%), bilateral cleft lip and palate; 69 cases (20.4%), unilateral cleft lip; 38 cases (11.3 %), cleft palate; 37 cases (10.9%), bilateral cleft lip; 3 cases (0.9%), and median cleft lip; 1 case (0.3 %).
8. The incidence of maxillary alveolar arch form was as follows:
1) The but-joint contact type accounted for 81.1%, the without contact type 12.3% and the overlap type 6.6% in unilateral cleft lip and/or palate patients.
2) The preamaxilla-projection type 68.1%, the but-joint contact type 22.3%, the premaxilla-climination type accounted for 8.3%, and the premaxilla-retraction type 1.3% in bilateral cleft lip and/or palate patients.
9. Type of malocclusion in the patients was as follows: crowding; 74.9%, mandibular protrusion; 55.9%, and cross bite; 51.4%.
10. The delivery age mothers ranged from 19 to 42 years old, and the average age was 27.9 years old.
11.49.4% of the patients were first-born children.

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