The purpose of this study was to clarify interrelations betwe en craniofacial dysmorphology and collapsed upper dental arch in unilateral cleft lip and palate.
Material and Method: Lateral and frontal cephalegrams and gnathostatic m odels of 27 male unilateral cleft lip and palate patients taken at the first examination (mean age: 9 years months) were used for this study. In the cephalometric analysis,25 measurements were measured in the saggital and frontal dimension. In the gnathostatic model analysis,9measurements representing maxillary collapsed dental arch ((1) whole dental arch collapse,(2) arch width collapse, and (3) arch length collapse) were measured on the three-dimensional dental model graphics generated by the noncontact three-dimensional dental model analyzer ( UNISN VMS25OR ). Firstly, cephalometric measurements to represent the charac teristic craniofacial dysmorphology were distilled by comparison with the normative non-cleft data. Secondly, the correlation between these cephalometric measurements and model measurements were evaluated at the significant levels of 5 % and 1 % respectively. The significant pairs were examined according to each aspect of upper collapsed dental arch.
Results:
1. Com parative cephalometric analysis revealed characteristic craniofacial dysmorphology: (1) Midfacial growth retardation, lingual tipping of upper central incisor, low mandibular plane and increased mandibular length in the saggital dimension; (2) Increased interorbital distance, narrowed nasal width, mandiblar midline deviation and midpoint deviation of the upper and the lower central incisors from the facial midline in the frontal dimension.
2. In the saggital dimension, the whole dental arch collapse showed significant correl a tions with retruded maxilla and decreased midfacial depth. The decreased upper arch width showed significant correlations with decreased anterior basal height and increased mandibular length. The decreased upper arch length showed significant correlations with decreased midfacial depth, lingual tipping of upper central incisor, increased mandibular length and low mandibular plane. In the frontal dimension, the whole dental arch collapse showed significant correlations with mandibular midline deviation from the facial midline, and the decreased upper arch width showed significant correlations with mandibular midline deviation from the facial midline as well as narrowed nasal width. However, the collapsed upper dental arch showed no significant correlations with increased interorbital distance and midpoint deviation of the upper and the lower central incisors from the facial midline.
The results suggested that the collapsed palatal vault after surgical repair of cleft li p and palate influenced the following growth of the craniofacial structure resulting in characteristic distorted facial harmony.

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The purpose of this study was to evaluate the change in mucosal inflammation of the inferior turbinate and nasal structure of the parients with cleft lip and palate after secondary alveolar bone grafting by comparing the findings with those before treatment.
The subjects were 13 patients with cleft lip and palate who underwent secondary alveolar bone grafting. Before and 5-6 months after the surgery, biopsy of the inferior turbinate of the operated side was performed and examined microscopically. The nasal cavity on the same side was also examined by nasoendoscopy. The results were as follows:
1) There was no relationship between the size of the oronasal fistula and the degree of mucosal inflammation of the inferior turbinate.
2) There was no relationship between the cleft type and the degree of mucosal inflammation of the inferior turbinate.
3) There was a correlation between the degree of mucosal inflammation of the inferior turbinate and the frequency of reducing the inferior turbinate.
4) The degree of inflammation of the inferior turbina te tended to reduce after bone grafting.
5) The nasoendoscopic findings revealed no abnormal nasal structure after bone gra fting.
These results suggested that the nasal structure and inflammation of nasal mucosa improved by secondary alveolar bone grafting, and reducing inferior turbinate performed simultaneous with alveolar bone grafting has no adverse effect on nasal mucosa and structure.

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Having an opportunity to collaborate with Chulalongkorn University in Thailand, a comparative study on three-dimensional changes of the maxillary alveolar arch shape before and after lip repair in patients with unilateral cleft lip and palate was conducted between the materials of Thailand and our university. The patients in the Thai materials (group T) were applied an active plate before and after lip repair, however, materials in our university (group J) were applied a passive plate only. Thirty upper dental casts from 6 patients in both groups were analyzed and imaged by means of the three-dimensional dental cast analyzing system using laser scanning (UNISN Co. ). Group T included 3 stages, before application of active plate and before and after lip repair, but group J included 2 stages, before and after lip repair. The landmarks were set up on the computer imagings, and then the imagings were superimposed three-dimensionally on the selected landmarks. The three-dimensional pictures were illustrated on the tomographic pattern. The width (W), length (L), ratio (L/W) of basal alveolar arch and the angle of both segments were measured automatically.
The results were as follows: In group T, the distance of cleft in horizontal view decreased after an application of the active plate, and the shape of palatal vault in the frontal view became shallow and flat after lip repair. On the other hand, in group J, no change of the distance of cleft was recognized in two third of cases, and the shape of the palatal vault became deeper. The width increased significantly and L/W decreased in group T, however, the length increased significantly in group J. Maxillary alveolar arch seemed to be wider and shorter in group T and narrower and longer in group J along with the stage change.

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A patient with incomplete cleft lip and alveolus (classified (3,0,0) by Kamiya) in a growth period just before the maximum pubertal growth spurt underwent secondary bone grafting using particulate marrow and cancellous bone at the age of five years and seven months. The implications of bone grafting before eruption of the upper central incisor are discussed herein. The antero-posterior bony defect pattern of the alveolar cleft in this patient was type A (classified by Kita et al. ), that is, the mesiodistal width of the alveolar cleft was nearly constant as shown by computed tomography, and the mesiodistal width of the alveolar cleft on the nasal floor was larger than that on the alveolar crest. The tooth bud of the cleft-sided upper central incisor was observed to be displaced to the noncleft side from the median line by CT. The average width of the alveolar cleft was 9 mm and 2.5 g of bone chips were transplanted in the alveolar cleft region. The cleft-sided central incisor erupted one year after bone grafting, earlier than the noncleft-sided tooth. Roentgenography revealed that the mesial rotation of the upper cleft-sided central incisor was reduced and the lingual change of its axial inclination became less than that of the opposite one after bone grafting. The orthodontic labial movement and alignment of the upper cleft-sided central incisor began one year eight months after surgery. The growth direction of the maxilla did not change before and after bone grafting. The findings indicated that secondary bone grafting, performed before eruption of upper central incisor, improved the axial inclination of the malpositioned cleft-sided central incisor and simplified the orthodontic therapy.

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Nineteen patients with cleft palate, with or without cleft lip, who received re-pushback surgery for chronic velo-pharyngeal dysfunction were examined for speech production, velopharyngealf unction and cephalometricf indings. Of the 19 subjects,15 (79%)gained normal resonation and 14 (74%) showed normal or nearnormal speech. Fifteen (79%)gained sufficient velopharyngeal function and 2 (11%) showed moderate velopharyngeal function. Of the 10 subjects whose pre- and postoperative cephalograms were available, the ratio between velum length (PMF-U) and velopharyngeal distance (PMF-PPW) was increased in 8 (80%) and decreased in 2 (20%). In the latter 2 subjects, palatal fistula was developed after operation. In case of the patients without fistula, the velum was extended 0.7-0.9cm postoperatively and tended to lengthen with growth.

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The interdisciplinary approach is critically important for the treatment of cleft lip and palate patients with a jaw deformity. This paper describes a course of the treatment of a left unilateral cleft lip and palate patient with severe collapse of the maxillary dental arch and undergrowth of the maxilla.
A 20-year 10-month-old male patient was treated with a quad-helix appliance and multi-bracket appliance in order to expand the maxillary dental arch during preoperative orthodontic treatment. At the age of 22 years 8 months, alveolar bone grafting was performed with fresh autogenous particulate cancellous bone and marrow of iliac bone. Six months later, an osseointegrated implant was installed in the transplanted bone, and ther glossectomy was performed at the age of 23 years 8 months. Preoperative treatment was completed at the age of 24 years 4 months, and then two-jaw surgery was performed. Orthodontic retainers were placed in the upper and lower dentitions after the postoperative orthodontic treatment for 9 months. The patient underwent lip and nose repair and prosthodontic treatment in the period of retention. The patient was fairly satisfied with the improved facial appearance and stabilized dental occlusion.

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Goldenhar syndrome has a multifoc al malformation involving ocular, auricular and vertebral anomalies, it is reported that about 2 % of the patients with this syndrome have cleft palate.
Acase of Goldenhar syndrome with a velopharyngeal incompetence after palatoplasty was improved by palatal lift prosthesis.
A 7-year-old male was referred to our hospital because of a speech disorder. He was born with epibulber tumor, microtia, deafness, cleft palate, scoliosis and mental retardation. He underwent palatoplasty by Furlow's method at another hospital at the age of 1 year 6months, but hypernasality remained after surgery. It was recommended to treat him with a speech appliance at our clinic.
By the cephalometric r adiography with contrast media and nasoendoscopy, it was found that the soft palate was as long as that of normal children, but the movement of soft palate was hardly recognized. Palatal lift prosthesis was applied to him, and his hypernasality disappeared a half year after the application of the prosthesis. lt was suggested that the speech appliance is effective for treating patients with postoperative velopharyngeal incompetence because of poor movement of the soft palate.

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