[in Japanese]

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[in Japanese]

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Oronasal fistula is a complication which may be seen after palatoplasty. Prognostic results on 30 patients with surgical fistula closure in 1985-1994 at Kyushu University Dental Hospital were evaluated and classified into threegroups: “good”, “ acceptable ”, and “poor”. The results were analyzed in relation with characteristic factors of oronasal fistula and the results were as follows:
1. The results was “ good ” in cases when rotation flap with bone grafting was employed fo r the closure of the fistula located in the anterior portion of the incisal bone.
2. The result was “ good ” in cases with closure and bone grafting fo r the fistula located in the hard palate.
3. The result was “ poor ” in cases with large oval fistula (not less than 5mm in diameter) located in the posterior portion of the incisal bone and with closure without bone grafting.

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In a case of unilateral cleft lip and palate accompanied by extensive bone defects in the jaw cleft, cancellous bone was harvested from the posterior iliac crest and placed Branemark implant fixtures.
The patient was a 21-year-old female. About 15g of cancellous bone was harvested from the posterior iliac crest primarily to close an oronasal fistula and form an alveolar ridge for the placement of an implant. When preparing the graft bed, the enlarged inferior concha was partially resected because it interfered with the jaw cleft. The graft bed was made as large as possible and filled with all of the harvested cancellous bone. Six months after the operation, X-ray computed tomograms (CT) showed that the bone took well. In the tenth postoperative month, Branemark implant fixtures (3.75mm in diameter and 10mm in length; 3.75mm in diameter and 13mm in length) were placed in region 1and 2, respectively. At present, there is no evidence, though there has been only six months of followup after the operation, of bone resorption or inflammation, and the postoperative course has been favorable. When the implants were placed, the protruding graft was trimmed, and the removed portion of the bone graft was histologically examined. The bone graft consisted of relatively thick, mature compact bone with fatty marrow. This finding was considered to be an indication that the bone graft remained favorably fixed.

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At the Cleft Palate Center, School of Medicine, Fujita Health University,127 newborns (76 males and 51 females) with cleft lip and/or palate fitted with palatal plates right after birth underwent cleft lip surgery as early as possible and/or cleft palate surgery at an average age of 12 - 15months. They were continuously followes up until their dentitions were complete. Anomalies in the number of decidous teeth were investingated by means of dental casts and radiographs and compared with the records of 1122 kindergarten children representing a normal distribution of dentitions.
1. The congenital absence of the lateral incisor on the side in which the cleft was found in 11.8%of the children by the age of 3 years was the most conspicuous sign of insuffient number of teeth. Congenital teeth were found in 3.1% of them, but all of the teeth fell out within a couple of weeks. Between the two groups of children, there was no significant difference in the loss of mandibular teeth and teeth in the non-cleft part of the denitition This was attributed to the superior dental hygiene in the children who were followed up.
2. Supernumerary teeth were found in 23 (18.1%) of the patients, They grew particulary often in 34.1% of the patients with a cleft lip or a cleft lip and alveolus.
3. Between the two groups of children, there was no significant difference in the incidence of fused teeth. However, the incidence of twin teeth was significantly higher in these patients than in other children. They grew particurally often in patients with cleft lip or cleft lip and alveolus; 24 of 48such children had either supernumerary or twin teeth.

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A new type of impression tray to facilitate the taking of impressions for cleft patients was developed. It is often necessary to take impressions of infants for recording growth and make palatal plates for them, but it is difficult to fit the tray size to the width of the mouth and maxilla, especially in the cases of post-cheiloplasty. To deal with the difference between the width of the mouth and maxilla, a Width Variable Impression Tray was developed.
The length and the width of maxilla of the infants with cleft lip and palate were measured on study models. Based on this data, it was decided to construct an impression tray wich was width-adjustable using screw and spring devices. Two sizes of trays were developed.
The precision of the impression by the “ Width Variable Impression Tray ” was studied.
The results using this tray were almost the same as the original study model taken with a conventional tray. This “ Width Variable Impression Tray ” is easy to use and will adapt to any size of ma xilla. Therefore, impressions can be taken easily and accurately for all cleft palate infants.

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