The purpose of the present study is to clarify the speech-sound discrimination ability on 32 patients who received cleft palate repair at about 18 months of age and developed single misarticulation among 6 types of ones (CCPS group: Children with Cleft Palate Speech, ranged 6-11 years of age),10 nomal controls of children (NCC group, ranged 8-11years of age) and 10 normal controls of adult (NCA group, ranged 22-24 years of age). Data were based on the tests of speech-sound discrimination and identification for the speech sample involving misarticulations of 6 types and baby talk. Then, discrimination ability and hardness of discrimination in types of misarticulation were analyzed. The results obtained were as follows:
1. There were no significant differen ces between the three experimental groups on the discrimination ability including discrimination and identification for the speech sample employed.
2. Among each of the errornous sound in the speech sample, Lateralized misarticulation (LA) ranked with the hardest, Palatalized one (PA) and, Nasopharyngeal one (NA) followed, Glottal stop (GS) and Baby talk (BT) were ranked with ease in the hardness order of discrimination.
3.Among children with cleft palate, identification of errornous syllable which was common to his/her own sound of misarticulation tended high in patients with GS and/or NA, and tended relatively high in patients with PA.
These results may suggest that speech discrimination ability of the patient should be taken into consideration when the generalization of normalized articulation is required at the final stage of cleft palate speech clinic.

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Atotalof117subjectsconsistingof43incompleteunilateralcleftlips(UCL),47cornpleteurlilateralcleftlipandpalates(UCLP),27isolatedcleftpalates(CP), and40non-cleftchildrenwerecomparedlongitudinallyoncranio-maxillofacialgrowthand developmentusinglateralcephalogramsobtainedattheageof4,6, and8years. Theresults wereasfollows:
1) Concerning the development of the craninal base, no significant difference was found between the three cleft groups and non-cleft children.
2) Among the four groups, UCLP showed less maxillary growth followed by CP and UCL. At the age of 4 years, UCLP showed less both in antero-inferior direction and the abnormality in anterior development became obvious at age 6 and 8. The tendency become more obvious in girls than in boys. When compared with UCLP, CP showed greater in the downward. growth of the maxilla in spite of less in the forward. UCL revealed only a slight abnormality in the downward growth.
3) Development of the mandibl e showed less in UCLP, then followed by CP and UCL.
4) Abnormal maxillo-mandibular gnathic relation increased with age in UCLP and CP. The relation was the worst in girls with UCLP. In conclusion, the inhibition of the cranio-maxillofacial growth and development showed greater in UCLP, and then followed by CP and UCL. This tendency was more apparent in the anterior development of the maxilla in UCLP and abnormal gnathic relationship increased with age.

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Dimensional and angular variables of velopharyngeal closure on the lateral cephalograms in patients with cleft palate were analyzed in association with velopharyngeal function. A total of 90 patients with cleft palate aged about 4 years were assigned to each of the 3 groups, i. e., incompetence group: 12, fairly incompetence group: 18, and competence group: 60. Materials include lateral cephalograms at rest, at phonation /a/ and /i /, then the variables were measured and compared. The results obtained were as follows:
1. Dimensional variables of posterior pharyngeal wall and hard palate, height and depth of nasophrynx, and distance between soft palate and posterior pharyngeal wall during phonation showed less as the groups, competence<fairly incompetence<incompetence.
2. Thickness of the soft palate during phonation showed less as the groups, competence<fairly incompetence<incompetence. There were a tendency for thick and short of the soft palate during phonation in many patients.
3. Mobility of the soft palate during pho nation /a/ showed better than /i/ in incompetence group, however, those were about the same in the competence group.
4. Protrusion of the posterior pharyngeal wall during phon ation showed greater as the groups, competence<fairly incompetence<incompetence. Those during /a/ phonation showed tendency for more great that /U.
5. Combination of the mob ility with the soft palate and the posteroir pharyngeal wall during /a/. showed greater than /i/ in incompetence group while it was converse in the competence group.
6. Pull-up position located mostly between palatal plane and levator eminence line.

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To evaluate the effectiveness of visual training with Speech Training System (STS)for the treatment of articulation disorders in cleft palate patients, the therapeutic process was assessed objectively using the assessment method in four cleft palate patients who trained in a similar procedure.
Method: STS was an improved form of multi-function speech training aid (MFSTA). Its parameters are alomst the same. The treatment progress was assessed objectively using a method described previously.
Results: Display of the parameters (palato-lingual contact, frication, plosion, airflow and voicing) greatly facilitated learning of the fricative and affricative sounds. The therapeutic period using visual feedback was shorter than that without visual feedback. In conclusion, STS is useful for articulatory treatment in patients with cleft palate.

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This study was undertaken to investigate the relation b etween histochemical findings of levator veli palatini muscle fiber compositions and fiberscopic findings of velopharygeal movement in patients who underwent operation for cleft palate. Eight of these patients who were candidates for pharyngeal flap surgery for velopharyngeal incompetence were the subjects. Velopharyngeal function for each subject was investigated using nasopharyngeal fiberscope prior to surgery. Specimens of the levator veli palatini muscle were removed at the time of surgery. Specimens were fixed by quick-freezing, and stained with H-E and ATPase histochemistry in cryostat sections.
The results were as follows:
1. For two subjects showing adequate timing of velum movement, this was the coronal pattern of velopharygeal movement, and the muscle fibers were arranged in mosaic pattern of type 1,2A and 2B fibers.
2. For four subj ects showing poor velum movement, this was coronal to circular or circular to sagital, and the muscle fibers compositions were variable compared to those of subjects with adequate velopharyngeal movement.
3. For the remaining two subjects sho wing immobile velum, no muscle fiber was observed. It was suggested that histochemical findings correspond to fiberscopic findings of velopharygeal movement.

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The purpose of this study was to investigate the three-dimensional (3D) changes in the nasomaxillary complex after rapid palatal expansion in isolated cleft palate patients. In seven individuals with cleft palate, CT scanning was performed before and after expansion. A 3D structure was reconstructed from axial CT scanning, and its coronal split images were compared to evaluate the affected site. Bone density distribution was also observed to clarify the interrelation between morphological changes and mechanical characteristics.
From the results, either wedge-like or parallel opening of midpalatal suture w ere observed. However, in some cases, the palatine bone was not expanded. Expansion of bony remnants of the palate and upper part of alveolar ridge were recognized in all subjects, though not found in the superior region of some cases. In subjects who showed uniform distribution of high bone density on the inferior part of the zygomatic arch, there was a tendency transmit the expansion force to the upper structure. These findings suggested a wide variety of responses in the expansion of the collapsed alveolar segments, which might be affected by causes such as structural variation after surgery and bone quality by nature, among the patients.

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In the course of treatments of congenital malformation, an informed consent is a matter of importance for the establishment of parents's cooperation. The questionnares method on the informed consent for the treatment of the patients with clefts was conducted to the members of parental societies. The analysis from the 212 respondents of questionnairs were as follows:
A total of 126 r espondents (63 %) were showed satisfaction with informed consent before the first operation, however, the remaining 37 % of responders showed not enough. The results may suggest that more effort is required to obtain well understanding in the process of consultation, counseling and care program.

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Cases of Beckwith-Wiedemann syndrome (BWS) combined with cleft palate are rare. In this report, a case of BWS involving cleft palate and recurrent laryngeal nerve paralysis which showed velopharyngeal incompetence after palatoplasty was reported.
A 6-year and 4 month-old boy was referred to our hospital because of a speech disorder. He was diagnosed as BWS at the department of genetics in a children's Medical Center immediately after birth. He underwent palatoplasty and tongue plasty there, but his speech showed hypernasality and breathy hoarseness.
He was advised to apply for a speech appliance for velopharyngeal incompetence and was referred to our clinic. A palatal lift prosthesis was initially adapted because of his short and weak-moving soft palate and severe gag reflex, and then followed by a speech-aid 11 months later. His velopharyngeal function was assessed as in good condition a year after the treatment. We suggest that the speech appliance is effective for treatment of velopharyngeal incompetence in patients who are thought to be poor candidates for secondary surgery.

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Nepal is one of the poorest countries in the world, and medical treatment in Nepal is behind the times. It is assumed that 40,000 patients of cleft lip and palate in Nepal exist, however, almost no surgeons can perform operations of cleft lip and palate. We have government organization) since 1995 for a total of 3 times in order to perform cleft lip and palate. operations in Nepal. In order to continue as medical treatment volunteers, it is important to make the patients aware of their condition and give hope for recovery. Thus a survey of CL/P patients and their parents, through a questionnaire focusing on the amount and level of physical and social stress in their daily lives, in addition to their knowledge of treatment available to them in Nepal, was performed. In Nepal, CL/P patients are left untreated due to economical reasons and lack of medical treatment information. If an opportunity exists, all hope for treatment of CL/P. Operation demands are very high. It is our intent to continue our support of the project in order to treat the people of Nepal.

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The situation after application of the Hotz type orthopedic plate to cleft patients was investigated. The cases were 72 bilateral cleft lip and palate (BCLP),146 unilateral cleft lip and palate (UCLP),18 cleft lip and cleft palate (CL+CP) with no continuity between the clefts of the lip and palate, and 70 isolated cleft palate (CP) patients a total of 306 patients.
The results were as follows:
1. The average initial age at the application of the plate was more than one month for all types of cleft, and notably later in CP.
2. The incidence of discontinuance was higher in less severe cleft types. In addition, the percentage of discontinuance increased when cleft of the lip was incomplete in BCLP and UCLP.
3. The average age at discontinuance in BCLP and UCLP was 1 year 3 months and close to the time of palate surgery, while it was less than 1 year in CL+CP and CP. In other words, the existence or absence of alveolar cleft influenced the situation after application of the plate. In CP, the age at discontinuing was earlier as the anteroposterior extent of the cleft palatal decreased.
4. There was no relationship between the initial age and the age at discontinuance in any cleft type.
From the results, it may be advisable to attempt to use the plate in BCLP and UCLP even if the first visit of the patient is late. However, in CL +CP and CP, further investigation is needed to determine the clinical value of the plate because of early discontinuance in many cases.

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The purpose of this study was to investigate the effect of the Hotz type orthopedic plate in isolated cleft palate. Twenty-six cases of isolated cleft palate were divided into 2 groups according to the period of wearing the plate. Maxillary growth was determined by comparing 2 three-dimensional maxillofacial models, which were made at the patients' first visit and at the time of palate surgery.
There were no differences in any dimension between the 2 groups at the first visit, but the results obtained from the model at the time of palate surgery were as follows:
1. In downward dimension, the posterior part of the dental arch grew more in the group with plates.
2. In forward dimension, the whole dental arch showed a tendency to grow more in the group with plates.
3. There were no differences in lateral dimension between the two groups. From this study, the growth changes of the maxilla, at least from the newborn period to the age of around 20 months, was favorable in the group that wore plates. The cause of these results can only be speculated, and to what extent these findings suggest a clinical advantage in the patients future is unknown. However, considering the fact that even the maxilla of unoperated clefts tend to be positioned posterosuperiorly, it would be advisable to attempt to use the plate in isolated cleft palates.

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S incet he establishmenot f this clinica t MiyazakiM edicalC ollegei n 1978, t here have been 441 cases of cleft lip and/or palate. Among them,312 primary cases were analyzed statistically.
The result were as follows:
1. The total number of prim ary cases during the past 19 years was 312, and the mean was 12.9 ger year.
2. Clef t morphology was classified into four categories, cleft lip and/or alveolus (CL) in 90 cases (28.8 %), cleft lip and palate and/or alveolus (CLP) in 81 cases (26.0 %), cleft palate only (CPO) in 111 cases (35.6 %), and submucous cleft palate (SMCP) in 30 cases (9.6 %). CPO cases were most frequently observed.
3. The laterality in CL and CL P cases was unilateral in 78.4 % and bilateral 21.6 %. Left laterality (1.7: 1) was noted in unilatereral cases.
4. The mean age of mothers at delivery w as similar to the normal group.
5. In CL and CLP cases,53.3 % and 63.0 % of those were referred b y obstetricians respectively, and 38.8 % of CPO and 46.7 % of SMCP were referred by pediatricians due to speech problem.
6. CL and/or CP were also found in 22 families representing 7.1 % of total propositi.
7. Associated congenital anomalies were found in 26.4 % of all cases, and th ey were more frequently found in CP and SMCP.

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