Aerodynamic variables such as oral air pressure (Goto,1977, Kuehn and Moon,1993), nasal air pressure (Tachimura,1985, Kuehn,1993) and nasal air flow (Tachimura,1992) have been reported to be involved in the regulatory system of velopharyngeal function during speech. Tachimura et al. (1993) clarified that levator veli palatini muscle activity is increased in relation to the flow rate of phonatory air that is emitted from the oral cavity into the nasal cavity through the veloph arynx of normal speakers and patients wearing a well-adapted speech appliance. This implies that nasal air, which is allowed to flow into the nasal cavity through an oronasal fistula, could influence levator muscle activity during speech. The purpose of this study was to examine the effect of temporary closure of an oronasal fistula on levator muscle activity. Five cleft palate patients who received surgery were used as subjects. The subjects were classified into two groups (VPC group and VPI group) according to their velopharyngeal function. Smoothed EMG of the levator muscle and oral air pressure were recorded. Two experiments were performed; In the first (Condition- I) an oronasal fistula was left unclosed so that respiratory air could eacape into the nasal cavity, and in the second (Condition- II), the oronasal fistula was tightly closed by means of packing it with cotton. The subject produced the speech sample /pω/ 20 times in each condition. Oral air pressure increased in association with the temporary closure of an oronasal fistula for all subjects in both groups. There was no significant difference between levator muscle activity in condition- I and that in condition-II for all subjects in the VPI group. However, levator muscle activity in condition- II was significantly smaller than that in condition- I for all subjects in the VPC group (p<0.01; t-test). The results suggested that the oronasal fistula can affect levator muscle activity in patients with adequate velopharyngeal function and nasal air flow may be involved in the regulatory system of velopharyngeal function irrespective of the place where phonatory air escapes into nasal cavity.

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Many investigators have reported that surgical repair of palatal clefts inhibits maxillary growth. Especially, mucoperiosteal denudation of palatal bone and scar tissue following surgery arrest transverse growth of the alveolar bone and produce a narrow deformed dental arch. In orthodontic treatment, due to the binding effect of the scar tissue, it is difficult to expand the narrow dental arch and to maintain the treatment results. Imformation about scar tissue areas is very useful for orthodontic diagnosis, treatment planning and prognosis in cleft palate patients. However, it is difficult to identify the scar tissue visually, and there is no reliable method to determine scar tissue areas. To solve this problem, the laser doppler flowmeter was applied to differentiate scar tissue from normal palatal tissue. The effectiveness and reliability of the method were also discussed in this article. The results were as follows:
1. By pressing larger palatine foramen with the force of 300 g, decrease in tissue blood flow was found on the entire palatal surface in non-cleft subjects.
2. Tissue blood flow was unchanged in the anterior portion of palates of cleft palate patients receiving 300 g pressure on the larger palatine foramen.
3. Histological observations suggested that laser doppler flowmetry is effective to determine the scar tissue area, based on the difference in circulatory conditions between the scar tissue and normal tissue.

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Klippel-Feil syndrome( K-FS) is a rare disease with adhesion of cervicalv ertebraea nd is associated with other malformations including cleft palate. Clinical findings on two cases of K-FS out of 200 cases of cleft palate who underwent orthodontic treatment in our clinic are presented. Case 1 is a 10-year-oldb oy with cleft palate, fusion of cervicalv ertebrae (C3 and C4), congenital heart anomaly, inguinal hernia, rete testis, ankyloglossia, numerous impacted teeth and mirror movement when walking. Case 2 is a 8 year-old-boy with cleft lip and palate, fusion of cervical vertebrae (C4 to C6), congenital heart anomaly and webbed neck. General diagnostic points and occurence of K-FS with cleft palate are discussed.

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This clinical and statistical study was undertaken on two hundred and eighty-nine cleft cases, and particulate marrow and cancellous bone grafting was performed in the alveolar clefts of these cases from 1982 to 1992. There were 181 unilateral cleft lip and palate,57 bilateral cleft lip and palate,41 unilateral cleft lip and alveolus, and 10 bilateral cleft lip and alveolus cases. The range of the age at the time of the operation was from 7 years and 4 months to 33 years and 0 month, and the geometric mean age was eleven years and eleven months. The frequency of the cases grafted under eleven years of age was 41.9%. The number of alveolar clefts, on which the canine was not erupted was 132 of 347 clefts. There was the tendency that the operation was performed at a later age in cases with bilateral cleft lip and palate than in those with other cleft types. The average width of each alveolar cleft was calculated, and distributed from 0 mm (incomplete cleft type) to 21 mm. The frequency of the alveolar cleft, which average width was 7,8, or 9 mm, was relatively high (14%). Wide clefts, with an average width of more than 11 mm, accounted for about 1/3 of all clefts. The weight per case of PMCB materials transplanted in the alveolar clefts was measured, and it correlated with the average width. The geometric mean weight per case was 5.0 grams. These results were compared to our earlier studies of the bony bridging in alveolar clefts, and the following was strongly suggested.1) Bone grafting should be performed at a younger age.2) More PMCB materials will be needed for grafting in alveolar clefts.

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Five cases with a cleft lip and/or palate and associated craniofacial bone anomalies were presented. In addition, the statistical frequency of the combination and the clinical management of such cases were discussed.
Case 1: A 7-y ear-old male had a unilateral cleft lip and a craniofacial cleft (Tessier type 10 cleft). Primary repair of the cleft lip was performed at the age of 3 months, and cranio-orbital (left) reconstruction was performed at the age of 30 months.
Case 2: A 6-year-old female had a uni l ateral cleft lip and palate and craniosynostosis (plagiocepha ly). Primary repair of the cleft lip and palate was performed at the age of 7 months and 23 months respectively, and cranio-supraorbital reconstruction was performed at the age of 42 months.
Case 3: A 4-year-old female had a median cleft lip and a craniofacial cleft (Tessier typ e 14 cleft). Anterior skull base reconstruction was performed at the age of 16 months, and primary repair of the median cleft lip was performed at the age of 40 months.
Case 4: A 3-year-old male had a median cleft lip and a craniosynostosis (trigonocephaly). Craniosupraorbital reconstruction was performed at the age of 17 months, and primary repair of the median cleft lip was performed at the age of 29 months.
Case 5: A 2-year-old female had an isolated cleft palate and craniosynostosis (trigonocephaly). Cranio-supraorbital reconstruction was performed at the age of 10 months, and primary repair of the cleft palate was performed at the age of 15 months.
Using Japanese statistical reports, craniofacial bon e anomalies were predicted to appear in 5% of all cleft lip and/or palate patients.
For the clinical management of these patients, considerations of appropriate diagnostic techniques, operative procedures for craniofacial surgery, and the timing for reconstruction of the anom alies must be made.

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One of the most important purposes of secondary bone grafting to the alveolar cleft is orthodontic closure of the gap in the dental arch without any prosthesis. To accomplish orthodontic closure of the dental arch, it is very important to make a wide graft bed and to fill this graft bed completely with particulate marrow and cancellous bone.
The anterior iliac crest has been the most common donor site for bone grafting in the maxillofacial skeleton. But the posterior part of the ilium contains appreciably more cancellous bone and marrow than the anterior region.
We have experienced 22 cases of secondary bone grafting to the alveolar clefts using autogenous particulate cancellous bone harvested from the posterior iliac crest. The graft bed size, transplanted bone volume, operating time and total blood loss of the cases that underwent bone harvested from both anterior and posterior iliac crest were assessed in this paper.
The results were as follows:
1) Based on the graft bed size and transplanted bone volume, an anterior: posterior ratio was about 1: 2.
2) Based on the operating time and total blood loss, an anteior: posterior ratio was also about 1: 2.
3) Assessment of postoperative morbidity concerned with bone harvesting revealed that posterior iliac crest surgery had a more decreased morbidity than by anterior iliac crest surgery.
In conclusion, posterior approach to the ilium has the advantages of more bone being available and fewer complications. It also has the disadvantages of increased operating time and the necessity of repositioning the patient during anesthesia. However, the advantages are considered to outweigh the disadvantages, and posterior approaches to the ilium is considered to be the most useful procedure for the cases which have wide alveolar bony defect and need a greater amount of cancellous bone to be transplanted.

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