The purpose of this study was to trace the change in the transplanted bone after secondary autogenous particulate cancellous bone and marrow grafting to evaluate the factors affecting resorption of the transplanted bone.
The materials consisted of radiographs taken just after and 3 and at least 6 months after grafting of 133 alveolar clefts of 108 cleft patients at the First Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital from 1987 to 1996.
Resorption of the transplanted bone were classified by reduction of the vertical height into three groups: less than one-third, between one-third and two-thirds, and more than two-thirds. The evaluated factors were (1) patients age at time of operation, (2) cleft type, (3) development stage of canine, and (4) purpose of bone grafting.
In patients under 12 years old, bone resorption was less than in the older patients. On the other hand, better results were obtained in the patients of unilateral clefts than those of bilateral. When the canine adjacent to the. alveolar cleft had started erupting from alveolar bone and its root was incomplete at the time of operation, bone resorption tended to be slight. In cases who underwent surgery to enable tooth movement into the grafted bone by natural eruption or orthodontic force, successful results were obtained more often than in the cases undergoing surgery for other purposes.
As a consequense, it was sug gested that continuous mechanical stress on grafted bone as well as general and local bone remodeling activities may influence the prognosis of secondary autogenous particulate cancellous bone and marrow grafting in alveolar cleft.

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The purpose of this study was to observe the healing process of the palatal wound with bone denudation in order to elucidate the mechanism of maxillary growth inhibition following palate repair.
Thirty-two male rats (4 weeks old) underwent excision of mucoperiosteum on one side of the hard palate. From 2 to 12 weeks after surgery, at regular intervals, palatal wounds were observed by light and scanning electron microscopes. Histological findings were compared with the conditions of the nonoperated side.
As a result, it has been determined that the process of regeneration of mucoperiosteal excisional wound can be divided into 4 phases as follows:
The first phase shows the proliferation of thin collagen fiber and reticular fiber. They formed a rough network in wounded connective tissue and were connected to a rough bone surface. The palatal bone was regenerated rapidly by osteoblasts. The second phase is characterized by the appearance of Sharpey's fibers between palatal bone surface and collagenous layer. Both connective tissue and palatal bone continued regeneration. In the third phase, Sharpey's fibers were buried in the regenerated bone, and the connection between the bone and connective tissue became firmer. In the fourth phase, massive collagenous layer was closely attached to the bone surface. Sharpey's fibers, however, remained in the boundary region between the bone and connective tissue.
The findings suggested that Sharpey's fibers can be considered a cause of maxillary growth inhibition following palate repair.

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Maxillofacial models of infants with different types of cleft were examined in order to clarify three-dimensional morphological characteristics. The subjects included were incomplete unilateral cleft lip (i-UCL): 13, incomplete unilateral cleft lip and alveolus (i-UCLA) 19, complete unilateral cleft lip and alveolus (c-UCLA): 16, incomplete unilateral cleft lip and palate (i-UCLP): 14, complete unilateral cleft lip and palate (c-UCLP): 50, complete bilateral cleft lip and palate (c-BCLP): 13, and isolated cleft palate (CP): 14. Maxillofacial models were made at the age of one month, and three-dimensional coordinates were established with five reference points on the alveolar process. The location of the points in relation with the coordinates were measured, and the following results were obtained. There was a slight horizontal deviation of the incisal point toward the cleft side in i-UCL, however, the maxillary arch growth was more favorable than in other cleft types, thus the i-UCL was used as a control of nearly normal subjects. In i-UCLA and c-UCLA, the incisal point was located closer to the midline than that of i-UCL, however, both the incisal and canine points on the cleft side deviated upward to the alveolar cleft in the vertical dimension. In i-UCLP, underdevelopement of the maxillary arch was slight compared to that of i-UCL, but there was a widening of the maxillary arch and lateral displacement of the major segment at the posterior maxilla. The minor segment in c-UCLP was located superiorly and posteriorly compared to that of i-UCL, and the maxillary arch in CP displaced posteriorly with superior displacement of posterior portion, while downward growth of the lateral segments in c-BCLP was similar to that of i-UCL. These results showed that the patients with palatal cleft, except c-BCLP, already showed underdevelopement of the maxillary arch at the age of one month, thus it is advisable to consider the application of presurgical orthopedics for these patients.

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To clarify the effectiveness of speech aid appliance (SAA) in cleft palate patients with velopharyngeal insufficiency (VPI).102 cleft lip and palate patients underwent prosthodontic treatment and follow-up for 5 years at the speech clinic of School of Denti-str y, Showa University were assessed.
The results were as follows:
1. The early operation group of 49 (88 %) patients showed more satisfactory results than the late operation group of 12 (52 %) patients.
2. In the early operation group,42 (95 %) patients wearing SAA before 6 years old showed more satisfactory results than 6 (55 %) patients wearing them at 7-18 years old.
3. In the late operation group,3 (100 %) patients wearing SAA before 6 y ears old showed more satisfactory results than 20 (43 %) patients wearing them after 7 years old.
4. Fifty-three (85 %) patients wearing speech bulb appliances (SBA) ach ieved adequate velopharyngeal function after one year of treatment. Eleven patients with severe VPI wore both SBA and palatal lift prosthesis (PLP). Five patients with slight VPI wore PLP.
5. Most patients achieved adequate or marginally adequate velopharyngeal func tion in less than 6 months of use. The early operation group had higher improvement rate than the late operation group.
6. In the early operation group, SAA of 40 % of the patients was removed without surgical treatment and that of 60 % of the patients with surgical treatment.
7. In the late operation group, SAA of 30 % of the pat ients was removed without surgical treatment and that of 70 % of the patients with surgical treatment.
8. Five patients who wore SAA permanently had unsat isfactory results.

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Facial morphology was assessed in 28 patients with unilateral cleft lip (CLP group; 9 patients with cleft lip and palate, CLc group; 11 patients with complete cleft lip and alveolus and CLi group; 8 patients with incomplete cleft lip) who had undergone lip repair by the same surgeon and surgical procedure. The patients were assessed just prior to surgery and 2 weeks,1 month,3 months and 1 year postoperatively with the use of three-dimensional facial measuring apparatus "Voxelan NKV-300DS" (Haman° Engineering Co. ) in which laser scanner and cameras are equipped for non contact measurement.
Analysis of the nasolabial configuration in the three groups before surgery and the postoperative course revealed:
1. Prior to surgery, the no se tended to deviate toward the normal side in all 3 groups. Nasal deformation and deviation was most noticeable in CLP group, followed by CLc and CLi in that order.
Following surgery, the nasal alae on both sides shifted medially. The nasal ala on the cleft side moved markedly anteriorly and medially to the same or more anterior position as the normal side. Nasal apex and columellar base moved close to the midline. Thus the nasal deformation was corrected and kept symmetrical.
2. Prior to surgery, the midpoint of cupid bow deviated markedly toward the normal side in all 3 groups, whereas the angle oris on the cleft side was positioned more laterally and posteriorly than that on the normal side.
Following surgery, the midpoint of cupid bow moved close to the midline and no relapse was observed in 1 year. The midpoint of cupid bow showed the least protrusion in CLP group. The angle oris on the cleft side showed marked medial movement and that on the normal side moved slightly medially and anteriorly. Slight asymmetry in the position of bilateral angle oris remained in CLP and CLc group till 3 month.
3. Prior to surgery, the superficial content of the nasal a rea on the cleft side was greater than that on the normal side in all 3 groups, most notably in CLP group. This nasal deformation appeared to be improved after surgery.
4. The superficial content of the lateral lip area on the cleft side was lower than that on the normal side in all 3 groups both prior to and after surgery. Similarly, the superficial content of lip area on the cleft side was lower than that on the normal side.

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he purposes of this study were to clarify' whether continuous speech may induce levator veli palatini muscle fatigue for speakers with velopharyngeal incompetence, and whether a speech appliance (Bulb-PLP) in place can decrease the muscle fatigue during speech. Four patients who underwent surgery for cleft palate and required a speech appliance for improvement of their velopharyngeal incompetence, were selected as the subjects. Each subject was asked to pronounce more than 200 times /pu/ under both conditions of placement and removal of the speech appliance. A correlation coefficient between the number of pronunciations and values of smooth EMG activity of the levator muscle was calculated under each experimental condition. Absolute value of the correlation coefficient was significantly smaller under the placement condition than that under the removal condition for all subjects. Differential correlation coefficients between the two conditions were found to be statistically significant for three subjects out of four subjects. This result suggested that the levator muscle was likely to suffer from muscle fatigue with velopharyngeal incompetence left untreated and that a speech appliance in place can prevent muscle fatigue during speech. It is possible that the clinical effect of a speech appliance to improve velopharyngeal function is partly caused by its efficacy to decrease muscle fatigue.

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A female infant with complete cleft lip and palate, macrostomia, and epignathus concurrently was reported. This case weighed 2222g in the 35th week of gestation. The stalk of the mass developed from the nasal septum through the cleft palate. The excised tumor was 7 X 6 x 5,5 cm in size. Histologically, this huge mass consisted of components of the three ge rm layers as follows: nervous tissue, stratified squamous epithelium, connective tissue cartilage which were consistent with typical teratoma. It was considered that this case belongs to categories II of Arnold's and Ill-type of Ewing's and Schwalbe's classifications.

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In 1984, congenital velopharyngeal incompetent patients with typical faces were defined as velo-facial syndrome (VFS) and craniofacial morphology, velopharyngeal structure, intraoral findings, mental development, and treatment results of VFS was reported.
The purpose of this study was to clarify the telation between VFS and CAT CH22 syndrome, and the clinical features of CATCH22 syndrome patients in comparison with those of no syndrome patients.
The chrom osome status of 20 CVPI patients (10 patients diagnosed as VFS,1 patient suspected as VFS,9 patients without typical faces) were tested using FISH analysis. The clinicai findings and treatment results of patients with deletion of 22q11 were compared with those without deletion of 22q11. The results were as follows:
1. All patients who were diagnosed and suspected as VFS showed deletion of chromosome 22q11, and the diagnosis was CATCH22 syndrome. However, none of the patien ts without typical faces showed deletion of chromosome 22q11.
2. Most CATCH22 syndrome patients did no t have any of Calnan's triad. In no syndrome patients, the submucous cleft palate with Calnan's triad was observed most.
3. As a result of cephalometric analysis, both patients with short and thin soft palate and those with disproportion between the length of the soft palate and depth of the pharynx were recognized in CATCH22 syndrome. In no syndrome, patients with short and thin soft palate were the most.
4. CAT CH22 syndrome patients showed mild mental retardation. IQ scores which were obtained by the Wechstler Intelligence Scale ranged between 39 and 74 (mean: 59).
5. Cardiac defects were found in 5 of 11 patients (45.6% ), and ear anomalies were present in 2 of 11 patients in CATCH22 syndrome.
6. Patients with CATCH22 syn drome showed unsatisfactory treatment results and needed a longer period than the no syndrome patients to improve adequate velopharyngeal function by prosthodontic treatment.
7. It was cla rified that VFS was associated with deletions of chromosome 22q11 and was included in CATCH22 syndrome as well as velo-cardio-facial syndrome and conotruncal anomaly face syndrome. This study suggested that typical faces were critical factor to suspect CATCH22 syndrome Clinically.

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Speech, velopharyngeal function, and oronasal fistula of 88 patients with cleft palate, who received palatal surgery when about 1,4-5, and 7-11 years old, were examined, and the results were as follows:
1) Normal speech was obtained in 68.2% of the patients when 4-5 years old.
2) Most of the patients with normal speech showed adequate velopharyngeal clos ure function without oronasal fistula.
3) Incidence and causes of misarticulation varied with age at evaluation.
It was suggested that velopharyngeal function and oronasal fist ula are the most responsible factors for articulation of patients following cleft palate Surgery.

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An 8-month-old baby with upper median cleft lip deformity and other minor anomalies is presented.
The findings included a slight median notching of mucosal lip, asymmetry of philutrum, short labial frenulum, alveolar bone notching at mid-premaxilla, and fused teeth with deciduous central and lateral incisors on the right side of the mandible.
Lip repair with frenulectomy enabled correction of upper lip deformity.

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A longterm observation of speech and orthodontic care following a two-stage palatal closure on a patient with bilateral incomplete cleft lip and palate, who recieved initial soft palate closure at 1 yr-8 mos and hard palate closure at 6 yrs-11 mos of age, is presented. After the initial soft palate closure, an obturator was placed until the time of hard palate closure.
After taking an ordinaly course of speech, a palatalized misartaiculation in adition to distortion and substitution appeared at about 4 yrs-11 mos, but they all disappeared by 5 yrs-5 mos of age without any intervention. Mild nasal emission and/or nasality at 12 yrs of age appeared, but they didn't require any specific treatment.
An orthodontic treatment has begun at 7 yrs-8 mos of age with minor maxillary expansion during mixed dentition, maxillary teeth alignment and occlusion is achieved in good order with multi-blanket appliance in permanent dentition.
The case presented here with two-stage pal atal closure showed an ordinaly course of speech and orthodontic care though the mother showed an anxiety during obturation, however, it might be suggested that guidancfe for two-stage palatal closure and velopharyngeal closure is more important for the successful collaboration.

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Many cases of cleft palate combined with other congenital malformations have been reported but cases involving both cleft palate and tongue have been very rare. The tongue cleft is one of the characteristics of oral-facial-digital syndrome (OFDS). In this report, a case of cleft palate, tongue cleft, ankyloglossia, tongue tumor and digital malformations, as well as the difference between this case and OFDS was discussed.
A 2-month-old female was referred to our hospital bec ause of sucking disorder. She was born on September 9,1994 (3,276 g) with cleft palate, tongue cleft, ankyloglossia, tongue tumor, and digital malformations. Tongue plasty, frenectomy, and removal of tumor were performed at the age of 8 months, and palatoplasty by Furlow's method was performed at the age of 1 year 6 months. The velopharyngeal function became good, but retardation of speech development was recognized at the age of 3 years 9 months.
The present case with intraoral and digital findings were similar to OFDS, but she had no facial anomaly. The diagnosis of the patient should be just cleft palate with some anomalies rather than OFDS.

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A case of an 8-year-old Japanese male with Larsen syndrome exhibiting many characteristic facial and skeletal features was reported. This syndrome was first reported by Larsen (1950), but hitherto little has been known about orofacial anomalies.
In this report on Larsen syndrome, the following findings, dental and cephalometric analysis including three congenital missing permanent teeth in the maxilla and deformity of nasal bone were presented. In this case, the small angle of S-N-Rhinion was characteristic, as found by cephalometric analysis.

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The purpose of this study was to evaluate the postoperative stability of the velopharyngeal complex following a modified UVP procedure. Changes of vertical location of the base and thickness of the velopharyngeal complex were studied using lateral cephalograms of 11 patients with repaired cleft palate. Lateral cephalograms were taken at 1-year intervals during the first 3 postoperative years, and landmarks in the region of the velopharyngeal complex base were measured using a digitizer and analyzed with a personal computer. All of the patients received pharyngeal flap operation after they were 10 years old because of velopharyngeal incompetence following primary cleft palate closure with achievement of normal articulation when speech appliance was placed. The results were as follows: 1. The superior point of the velopharyngeal complex base showed downward dislocation 1-year later both at rest and during phonation of /a/, however, there were no significant changes thereafter.2. The superior point of the velopharyngeal complex base showed no vertical change during blowing following pharyngeal flap surgery, i. e., the point maintained about the same vertical position corresponding to the palatal plane.3. The thickness of the velopharyngeal comp lex base at rest, during phonation of /a/, and during blowing showed a tendency for decrease for 1-year, however, there was no significant change thereafter. From the above results, a modified UVP procedure is recommended in order to provide a stable velopharyngeal complex for various functions following surgery.

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Since 1991 when a Cleft Palate Team was established, a total of 639 patients with cleft lip and/or palate has been registered for the management in a total care system by the team until August 1997. Among them,433 patients who received primary lip and/or cleft palate surgery were subjected to analysis in the study, and the results were as follows:
1. Distribution of the patients according to the Cleft Type was Cleft Lip: 26, Cleft Lip and Alveolus: 70, Cleft Lip and Palate: 199, and Isolated Cleft: 138.
2. A total of 373 were patients who live in Niigata Prefec ture including 70 from Niigata City,32 from Nagaoka City,18 from Joetsu or Shibata City,253 from other districts, and the remaining 60 were from other prefectures.
3. Mean initial visits of 433 patients were at about 4.3 months to Oral-Maxillofacial Surgery, and then 332 were referred to the Speech Clinic at about 2 years 1 month,198 patients to Preventive Dentistry at 2 years 4 months,236 patients to Pediatric Dentistry at 5 years 9months,209 to Orthodontics at 13 years 1 month,7 to Operative Dentistry and Endodontics or Periodontics at 14 years 9 months, and 3 to Prosthodontics at 14 years 9 months old.
4. A total of 371 patients was under the management of OralMaxillofacial Su rgery,166of the Speech Clinic,127 of Preventive Dentistry,163 of Pediatric Dentistry,174 of Orthodontics,2 of Operative Dentistry and Endodontics or Periodontics, and 1 of Prosthodontics at the time of this study.

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[in Japanese]

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[in Japanese]

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