Kuehn (1991) described the effect of continuous positive air pressure (CPAP) therapy for hypernasality. Kuehn et al. (1993) reported that the effect of CPAP therapy may be attributable to the increase in levator veli palatini muscle (LVP) activity which is induced by increased nasal air pressure loading. LVP, however, can be activated also by an increase in oral air pressure (Goto, Kuehn and Moon). Thus oral air pressure might also be involved with the effect of CPAP therapy.
This study was disigned to determine whether the effect of CPAP therapy originates in increased nasal air pressure solely or in association with increased oral air pressure. Three normal adult subjects were used. Several levels of air pressure were applied during the production of Japanese /pu/ using originally devised instrumentation. The subject produced the speech sample more than 20 times at each level of pressure. Smoothed electromyographies of LVP (EMG), nasal air pressure (NAP) and oral air pressure (OAP) were recorded.
The results obtained were as follows:
1. Electromyographic activities were increased with nasal air pressure to a certain pressure level, which varied among subjects. As nasal air pressure above the level was applied, the electromyographic activity was decreased accordingly in all subjects.
2. Oral air pressure was also increased as the nasal air pressure was increased.
3. Single correlation coefficients between EMG and NAP were greater than those between EMG and OAP, while both correlation coefficients were statistically significant for all subjects.
4. Through multiple regression analyses based on EMG as the criterion variable and NAP and OAP as explanatory variables, LVP activities were statistically confirmed to be affected by both NAP and OAP with the F value reaching statistical significance. However, the T value for the correlation coefficient for NAP was significantly greater than for OAP.
It was concluded that the effect of CPAP is principally induced by increased nasal air pressure.

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In this report, we present a 2-year-5-month-old girl patient with rare facial cleft and supernumerary deciduous molars. Surgery has been performed on left transverse facial cleft, therefore a scar just lateral to the left angle of the mouth was appeared. Also, a slightly arching furrow extended from the left corner of the mouth upwards to the left distal canthus. Intraorally, cleft of the alveolar process was seen posterior to the maxillary left second deciduous molar, and the segment posterior to the cleft had two erupted supernumerary deciduous molars. Computed tomography and roentgenogram revealed that the cleft of the maxilla was extended from the alveolar region, dividing the sinus into two parts, and terminated about 20 mm below the zygoma. Also each upper first molar tooth germ was recognized on both sides of the cleft.
This case had a combination of clefts No.6 and 7 in Tessier's classification, with supernumerary maxillary right deciduous canine and maxillary left first and second deciduous molars.
The etiology of supernumerary teeth in this case were explainable by the relation to the cleft in “ field theory” and“ clone theory”.

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Epignathus is a very rare teratoma or double malformation, in which a tumor-like parasite attackes to the palate or base of skull. W e present a case of epignathus; a 4-month-old girl was brought to us by her mother who complained of existence of cleft palate and tumor formation of the palate. On March 6,1975, the epignathus was excised successfully. Its base was located on the upper part of the epipharynx and extended to the septum nasi. The head-like tip of the tumor was covered with white fine soft hairs and the remainder had a skin-like appearance. As excision of the tumor advanced, a tooth germ became visible. The excised tumor was 2× 2 × 4 cm cylindrical. On the whole, the tumor was covered with skin. Histologically, the skin and its structure were characteristic. The excised epignathus consisted of the fatty and fibrous tissues, mainly. The tumors was diagnosed histologically as teratoid malformation.
The postoperative course was uneventful and the patient was discharged and expected to receive palatoplasty. But unfortunately, the girl died of pneumonia at home 8 months after the operation, in November 1975.
From 1962 to 1981, we experienced only this case of epignathus with cleft palate among 3,119 cases with cleft anomalies of the maxillofacial region, during the same period at the Department of Oral & Maxillo-Facial Surgery, Faculty of Dentistry Tokyo Medical and Dental University. The occurrence ratio of this case was calculated as 0.032 % of cleft anomalies and 0.085 % of 1,176 cases with cleft palate alone.

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Prosthodontic treatment for most CLP patients is performed after surgical and/or orthodontic intervention. Prosthodontic considerations should be taken to prevent the relapse and collapse of the teeth and the alveolar segments after surgical and/or orthodontic intervention.
Equilibration between the upper and lower jaw has to be maintained, that is to say, some teeth adjacent to the cleft in the upper jaw should be splinted in order to increase the tooth-bearing ability.
The purpose of this study was to set up a criterion for the extension of the splint for bilateral CLP patients.
The findings were as follows:
1. The maximal biting force increased according to the extension of the splint. But the maximal biting force of the canine did not increase even if the splint was extended to the first or second premolar with a lateral segment.
2. Even if the second premolar was splinted in the same lateral segment as the canine, the maximal biting force of the canine did not increase significantly as compared with that of when the splint was extended to the first premolar.
3. In the case of the bilateral CLP patients, the tooth-bearing ability of the central incisor did not increase as much as in the case of unilateral CLP patients.

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Some cleft lip and palate patients need a speech-aid for the improvement of velopharyngeal insufficiency. The daily-use type of speech-aid, however, is rather difficult to use during orthodontic tooth movement. In those cases, we have to cease speech-aid wearing temporarily. To solve this problem, a fixed orthodontic appliance with a speech-aid bulb was designed and has been applied in active orthodontic treatment. This is composed of a fixed maxillary expander and a removable bulb, enabling velopharyngeal competence during orthodontic treatment. In this paper, the structure and the utilization procedure of this appliance are described in detail and a successfully treated case is presented. The effectiveness and problems of this appliance are also discussed.

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Modified glossopexy recently designed by Argamaso was performed on five infants with severe upper airway obstruction in Robin sequence. Three patients obtained airway patency immediately after glossopexy, but the other 2 patients did not. One patient with Treacher Collins syndrome had an extremely narrow pharyngeal lumen, and tracheotomy was performed as the final treatment. The second patient was obligated to use a nasopharyngeal tube to protect the upper airway obstruction 2.5 months after glossopexy.
In this report, we describe the clinical course of 5 patients and discuss criteria for glossopexy in Robin sequence based upon our experience.

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We carried out a statistical study of 2446 outpatients with cleft lip and/or palate (CL (P1) from the files accumulated at the Orthodontic Department Clinic of the Tokyo Medical and Dental University during the past 20 years. Since 1977,1237 of the 2446 patients have been registered for treatment.
The results were as follows:
1) The number of new patients increased yearly until 1983. The number of new registrations in recent years is about 120 per annum.
2) At the time of initial registration,43 % of the patients were 6-8 years old.
3) Orthodontic treatment was commenced at the age of 10 for 17.3 % of the patients.
4) Cleft type distribution was: Cleft lip (CL) 16.7 %, Cleft lip and palate (CLP) 65.1 %, Cleft palate (CP) 17.9 %.
5) Male patients were 54 %, while female patients were 46 %.
6) The residential area of the patients was mostly Tokyo and its adjacent prefectures.
7) The Clinic of Oral Surgery, Tokyo Medical and Dental University referred 62.7 % of these patients to the Orthodontic Clinic.
8) Butt-joint contact arch form was demonstrated in 65.1 % of the 441 UCLP patients and 61.2 % of the 125 BCLP patients.
9) Associated crossbite was observed in 94.8 % of CLP patients.27.4% demonstrated total crossbite. The frequency of crossbite in CP and CL patients was less than that in CLP patients.

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A clinico-statistical investigation of the associated congenital anomalies was made on 497 patients with cleft face, lip and/or palate who were examined at our department during from January 1967 to October 1992. The following results were obtained:
1. The number of patients with other associated congenital anomalies and/or syndrome was 50, which was a 10.0 % incidence rate.
2. Of the associated congenital anomalies, congenital heart disease was observed in 14 cases (2.8 %), auricular anomalies in 10 cases (2.0 %), anomalies of extremities in 10 cases (2.0 %), and urogenital anomalies in 8 cases (1.6 %).
3. In the patients with associated congenital anomalies, the number of associated congenital anomalies in a patient averaged 1.2, maximally 6.
4. Of 22 cases were diagnosed as a syndrome, Pierre Robin syndrome was observed in 14cases and the first and second branchial arch syndrome in 4.
5. The number of patients with cleft palate and the incidence of associated congenital anomalies tended to increase.

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