A questionnaire research was conducted to obtaine guidelines for future therapy for adolescent cleft lip and palate patients.
The subjects were selec ted from cleft lip and palate patients consulting the cleft lip and palate center of Kumamoto Kinoh Hospital or School of Medicine, Showa University in whom follow-up observation was feasible. The subjects were 13∼18 years (junior and senior high school students) and replies were obtained from these subjects and their guardians (87 patients,98 guardians).
The quesstionnaire sheet which was made up of 25 items was mailed to each guardia n and was answered separately by the patient and guardian. For each item one of 5 possible replies was selected. The main question items concerned the degree of satisfaction (treatment, school life, family life), anxiety (further education, employment, marriage, heredity), and recognition of impediment.
The results were as follows.
1) Both the patient and guardian expressed a high degree of satisfaction, with affirmative answers obtained in the majority of cases regarding satisfaction with treatment, school life, and family life.
2) No tendency to anxiety was found among the patients, with most patients replying“no an x iety”with regard to further education, employment, marriage, and heredity.
3) Among the guardians, most had no anxiety with regard to further education and employment, whereas a tendency to anxiety was found with regard to marriage and heredity, differing significantly from the patients.
4) Rega rding recognition of impediment, the replies of the patients and guardians were very consistent, with the high degree of recognition and the majority of replies stating that they recognized the presence of impediment. In most cases the patient was informed about his impedient during elementary school days from the mother or both parents.
5) Since it is predicted that problems r elated to future social activities may occur, it is considered necessary for the therapist to fulfill a mediatory role between the patient and guardian or patient/guardian and society.

View full abstract

Velopharyngealf iberscopice xaminationsw ere made on 35 patients( 4 years1 0 monthst o 17years 2 months of age), including 12 with bilateral cleft palate,12 with unilaltaral cleft palate, and 11with isolated cleft palate from February 1992 to March 1995 at Fujigaoka Rehabilitation Hospital, Showa University, and Departmento f Plastic and ReconstructiveS urgery, Showa University. All patients were examined with respect to the type and degree of closure of the phonemes /a/, /i/, /p/, and /∫/, and the results were comparedw ith those of the auditory assessmentb y speech therapists. The results were as follows.
1. The patie nts were grouped into four types of closure: soft palate primary type, lateral pharyngeal wall primary type, soft palate and lateral pharyngeal wall type, and soft palate and lateral and posterior pharyngeal wall type.
2. All the patients cat egorizeda s the soft palate primary type belong to either the group with no hypernasality or the group with mild hypernasality. The patients classified as the other three types showed various degrees of hypernasality.
3. There was no strong relation between age and type.
4. Longitudinals tudy revealed no patient to chan ge from one closure type to another during the prognosis period.
5. Mo st patientsw ith no hypernasalitys howed no differencei n the degree of closure of the phonemes.
6. When there were differences in the degree of closure for the phonemes, the consonants /p/ and /∫/ were better closed than the vowels /i/ and /a/ irrespective of the degree of hypernasality. The degree of closure in the consonants, both consonants showed no difference in the degree of closure, or /∫/ showed better closure than /p/ did. However, the degree of hypernasality varied between vowels. In the case of mild hypernasality, both vowels showed no difference in the degree of closure, or /i/ was better than /a/. In the case of moderate hypernasality, no tendency was observed. And in the case of severe hypernasality, both vowels showed no difference in the degree of closure.
7. There was no strong relation between age and difference in the de g ree of closure of the phonemes.
8. The tendency of the consonants being better closed than the vowels remained unchanged in the phonemes which changed their degree of closure during the prognosis period.

View full abstract

This paper discussesp sychiatric p roblems surrounding nine adolescentsw ith repaired cleft lip and palate who manifested any noncompliance during orthodontic treatment for mandibular protrusion. The results were as follows:
1. Some patients encountered ps y chologicald ifficultiesd ue to staring, ridicule, whispering, and teasing by other persons in relation to their facial impairment during orthodontic treatment. They were also more likely to deepen social introversion related to defective speech.
2. Reasonsf or noncompliancew ere:
1) followedb y adjustmentd isorders w ith nonattendancea t school and violence in the family.
2) those who manifesteds elf-diagnosticm anner associatedw ith dysmorphophobia.
3) depression.
4) those complainants who did not follow through with orthodontic recommendations.
Ambivalence of aggression and dependency was observed especially in cases 1),2), and 4).
3. Despite the simultaneous stresses, due to facial impairment, defective speech, family crisis, and hard schedules of school life, a few adolescents avoided psychological risks and could discover thei r own identity by placing priority on sports or hobbies, which played the role of sublimate action in defeating opponents.
4. Intro duction of consultation-liaison psychiatry to cleft lip and palate patients was emphasized to promote multidisciplinary attention to cleft lip and palate patients among operators, families and medical staffs.

View full abstract

Among 51 cleft lip and palate patients w ho visited Nihon University Dentistry Hospital at Matsudo since 1989,21 of them (41%) were Angle Class I anterior cross bite UCLP which was the most common case. Following previously presented Part 1, the authors compared and examined whether a morphological difference existed between 21 Angle Class I anterior cross bite UCLP patients with high frequencya nd 8 Angle Class I normal bite UCLP p atients; all 29 patients, aged from 7 to 16, underwent lateral roentogenographic cephalogram.
The following results were obtained.
1) Between Class I anterio r cross bite UCLP and Class I normal bite UCLP patients, there were a morphological differences in the denture and skeletal patterns related to the maxilla and mandible, except the mesial and distal relation of the mandible.
2) It was recognized that Class I anterior cross b ite UCLP patients had the occluision of concave type with undergrown maxilla and that Class I normal bite UCLP patients had the occlusion of con vex type with over-grown maxilla.
3) For both Class I an terior cross bite UCLP patients and Class I normal bite UCLP patients, there was a tendency that the axis of upper and lower incisors stood vertically toward the lingual side, which was more noticeable for Class I anterior cross bite UCLP.

View full abstract

Two cases had a severe retarded maxilla at the end of the puberty growth, although the growth and development had been controlled from the initial visit (6 years 10 months in case 1 and 7 years 11 months in case 2). Thus, surgical approach was performed by combining with orthodontic treatment, but position of the mandible with respect to the skull was normally located. As far as the facial profile was concerned, maxillary surgery could have been an efficacious procedure. However, it could not achieve enough displacement to improve overjet of the anterior teeth, so mandibular surgery was simultaneously performed. (Surgical correction of the cleft lip and palate inhibits normal growth of the maxilla. ) Mandibular set-back surgery alone would cause the reduction of oral cavity volu me. Therefore, we intended to increase the amount of maxillary advancement as much as possible and to decrease the amount of mandibular set-back. As a result, oral cavity proper volume after surgery slightly changed from 20.1cm3 to 20.8cm³ in case 1 and from 16.3cm³ to 16.6cm³ in case 2.

View full abstract

Four hundred sixty cases with cleft lip and/or palate underwent primary surgery at our department from Jan.1982 to Dec.1993. Among them, clinico-statistical analysis was made on 65 cases with bilateral cleft lip and/or palate. The following results were obtained.
1) These cases were 49 males and 16 females (sex ratio 3: 1),14.1 % of all cases.
2) They were 3 cases of cleft lip (CL),10 of cleft lip and alveolus (CLA) and 52 of cleft lip, alveolus and palate (CLAP).3
) By m orphological classification, cleft lip was 35 cases of bilateral complete and 11 of bilateral incomplete.
4) Associated congenital anomalies were found in 20.0 % of all cases.

View full abstract

A statistical investigation of the cleft position and numerical tooth abnormalities in permanent dentitions was carried out on 116 patients with cleft lip and/or palate who were treated at the Department of Orthodontics, Osaka Dental University from April 1, 1989 to March 31,1994. The third molar was excluded from the observation. The main findings obtained in this study were as follows
1) 1_??_3 type of the position of cleft was found in the highest frequency,63.5 %, followed by 1_??_23 type,21.7 % and 12_??_3 type,10.4 %, etc.
2) Out of 116 patients,72.4 % had numerical (conge nital missing/supernumerary) tooth abnormalities.
3) Among the 72.4 % of the cases,62.9 % had only congenital missing teeth, followed by only supernumerary teeth,6.0 % and both congenital missing teeth and supernumerary teeth,3.4%. One hundred sixty-one congenital missing teeth and 14 supernumerary teeth were found in 116 patients.
4) Among the 72.4 % cases, the cases found only in the maxilla were most frequent,6 2.1 %, followed by both in the maxilla and mandible,8.6 % and the cases only found in the mandible,1.7 %. One hundred forty-one congenital missing teeth and 13 supernumerary teeth in the maxilla and 20congenital missing teeth and 1 supernumerary tooth in the mandible were noted in 116 patients.
5) Among a total of 161 congenital missing teeth in 116 patients,2 was found in the highest frequency,60.3 %, followed by 5,23.0 %, etc. On the other hand, among a total of 14 supernumerary teeth in 116 patients,71.4 % was found in the 2 region.

View full abstract