An overlay denture with bite raising was applied to a bilateral cleft lip and palate (CLP)in a patient with severe skeletal discrepancy and overclosure. The bite raising was carried out immediately with the amount of 12mm at the central incisor and 7 mm at the first molar.
The purpose of the present study was to trace the course of adaptation after the bite raising procedure with the surface electoromyograms (EMG) technique.
Surface EMG from the masseter on both sides and from anterior temporal muscles during maximal voluntary clenching were recorded before insertion of the overlay denture. on the day of insertion, and at 1, 2, 5, 10, 15, 20, 25, and 30 weeks later.
The activity and asymmetry indices of the masseter and anterior temporal muscles, and integrated EMGs were analyzed to find the muscle activity. The findings were as follows:
1. As for the clinical sympt om, there was pain on the left temporomandibular joint during the period from the next day to 2 weeks after the insertion of the overlay denture.
2. For the activity index, though the value was -32.6% before trea tment, it became 0.9% at 30weeks after insertion of the overlay denture.
3. For the asymmetry index, thou gh the value was 39.8% before treatment, it became -12.9% at 30 weeks after insertion of the overlay denture.
4. For the muscle activity, the value of the masseter and temporal muscles at 30 weeks after insertion of the overlay denture significantly increased by 55% as compared with that of pretreatment.
The findings suggested that a CLP patient who has severe disharmony of alveolar arch and occlusion shows sufficient reaction of stomatognathic function to prosthodontic procedures accompanying immediate bite raising, and EMG evaluation is essential for such a prosthodontic procedure.

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The effects of early orthodontic management on dentofacial morphology were studied in anterior crossbite children with complete unilateral cleft lip and palate (UCLP). The subjects were six years old on average and Hellman's dental age II C -III A, all of them were followed-up in our hospital. Lateral cephalometric radiographs and oral plaster models of 8 UCLP children (+ group) who underwent orthodontic management in the late deciduous dentition (mean age 3.5 years) and 7 UCLP children (- group) who did not undergo orthodontic management were analyzed. The results were as follows:
1) Anterior and lateral expansion treatment for the maxillary collapsed arch significantly enlarged the maxillary and mandibular dental arch width and the maxillary dental arch length. The improvement in the overjet and the midline and symmetry of the maxillary dental arch were observed.
2) There was no significant difference between the + and - groups in lateral ceph alometric measurements, but the spatial position and depth of the maxilla in the + group indicated values approximately equal to normal values.
3) The upper lip prom inences of the + group were improved in comparison with those of the - group in the lateral cephalometric evaluation.
These results suggested that early management stimulated early growth of the maxilla, and improved the soft tissue profile and the maxillary and mandibular dental arch in size and shape.

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Each bone shape on the alveolar cleft margin of forty-two patients with unilateral cleft lip and alveolus was evaluated by X-ray computed tomograms. Then the spread of bone defect in the alveolar cleft was classified into four types (i.e., A, B, C, and D) on the horizontal plane and three types (i.e., +, //, ) on the frontal plane. Some distribution patterns were observed, though there was a great variety of bone defect form in the alveolar cleft three-dimensionally. On the horizontal plane of the alveolar crest level, type A had almost the same mesiodistal width of bone defect on both anterior and posterior portions of the alveolar cleft, and was the most frequent. On the basal bone side of the alveolar cleft, types A and B, deltaic bone defect form, were found in half of the subjects. In the frontal view, seventy percent of forty-two alveolar clefts had the uniform bone defect pattern (//), which showed nearly the same mesiodistal width of the alveolar cleft. Individual conditions of bone shape on the alveolar cleft margin could be expressed using three symbols from among A, B, C, D, (+), (//), (-) such as AB (//).

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There is much variety in speech disorders in submucous cleft palate (SMCP) patients. Some patients naturally have normal speech while others need surgical treatment at various ages. Therefore, SMCP is considered to be useful to evaluate the influence of surgery on craniofacial growth and dentoalveolar development.
In this study,11 SMCP patients were treated by the cleft palate team of Hokkaido University Dental Hospital including 6 non-operated patients.
Lateral cephalometric roentgenograms and cast models at dental age III A (mean age: 8 y 2 m± 8.3m) were used to evaluate craniofacial morphology and dental Arch Form. The results were as follows:
1. In operated cases, irrespec tive of the surgical age, vertical growth of the posterior part of the maxilla were restricted.
2. The maxillary growth was considered to be normal in non-operated cases.
3. It was suggested that the patient's age at operation is closely related to the restriction of anterior maxillary growth and transverse growth of the anterior part of the maxillary dental arch.

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Posnick's Le Fort I osteotomy, which allows for simultaneous management of maxillary hypoplasia, residual oronasal fistula, bony defects, and cleft-dental gap, was conducted in 6 adolescents with cleft lip and palate (unilateral in 5 and bilateral in 1 patient). This procedure involves approximation of two maxillary segments to close the cleft-dental gap. An iliac cancellous bone graft is simultaneously packed along the floor of the nose and into the cleft palate. Five of these 6 patients with marked disharmony of the upper and lower jaws simultaneously underwent mandibular setback by sagittal splitting osteotomy.
Complete closur e of the oronasal fistula was attained in all patients. Bony bridge formation in the alveolar cleft was observed in six of seven clefts. In all patients surgical closure of the cleft-dental gap was successfully executed without dental prosthesis. All the patients maintained a positive overjet and 5 patients maintained a positive overbite. One patient had a neutral overbite after surgery because of insufficient fixation of split rami mandibulae. There were few complications.
This method served to close the dead space in the palate while a pproximating the labial and palatal flaps to allow for closure of the oronasal fistula without tension. There was no need of a partial denture to close the cleft-dental gap. This surgical treatment served not only to simultaneously solve these residual problems due to the alveolar cleft and aesthetic problems, but also to reduce mental and economic burden, as well as to save time.

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Although several complications are encountered after cleft palate operation, airway obstruction due to micrognathia is thought to be the most risky complication for Robin sequence with cleft palate. So some doctors advises prolonging the cleft palate operation until the mandible grows up to be enough size. In this case, it may interrupt the development of normal speech. In order to investigate these problems, we retrospectively reviewed the records of 28 patients with Robin sequence with cleft palate. All of these cleft palates were of the soft cleft palate type. Concerning the degree of symptoms using Monroe's criteria, over two-third of the patients in our study were diagnosed as being severe cases. However, none of these patients required a tracheotomy though almost all were hospitalized for more than one month. Twentysix among these patients underwent cleft palate operation. Based on our study, there seemed to be no special difference between a patient with Robin sequence with cleft palate and an ordinary cleft palate patient as to postoperative complications and average age or weight at operation.

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