The purpose of this study was to evaluate the effectiveness of mixing hydroxyapatite granules (HA) with autogenous particulate cancellous bone and marrow (PCBM) in secondary alveolar bone grafting of cleft patients. The subjects consisted of 42 patients who received grafting of only PCBM (group 5), and 30 patients who received grafting of the mixture of PCBM and HA (group M), at the First Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital, from 1987 to 1996. All of the patients studied were over 13 years old, because HA mixture-grafting is applied only to adolescent patients in our clinic. Serial radiographs were taken and evaluated before, just after, and more than 6months after the bone grafting. Postoperative resorption of transplanted bone, the change of interdental alveolar height, and clinical complications were compared between the S and M groups.
Postoperative resorption of transplanted bone in group S was revealed to be slight in 53.1%, moderate in 32.6%, and severe in 14.3%, while the resorption in group M was slight in 71.4%and moderate in 28.6%. No severe resorption was observed in group M. The interdental alveolar height tended to be maintained at a more satisfactoly level in group M than in group 5, postoperatively. Namely, postoperative resorption of transplanted bone was found to b e less in group M than in group S. However, postoperative complications, such as dehiscence of the surgical wound and exposure of the grafted materials, were seen more often in group M than in group S. In conclusion, grafting the mixture of PCBM and HA was effective in preventing postoperative resorption of transplanted alveolar bone in adolescent cleft patients.

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It has been reported that the changes of soft tissues do not coincide with the movement of hard tissues in two-jaw surgery. Although a few reports discussed the effect of orthognathic surgery on the nasal tip and upper lip region, little was mentioned about changes in the cheek line, and no quantitative analysis was performed.
In this study, the morphological changes of the soft tissue profile (mainly the cheek line)were examined in unilateral cleft lip and palate patients who had anterior reversed occlusion and who had undergone two-jaw surgery.
The subjects were 12 unilateral cleft lip and palate patients (8 females and 4 males) on whom orthognathic surgery was carried out at Niigata University Dental Hospital.
The subjects were divided into two groups:
1. Complete Le Fort I osteotomy group (t he whole maxilla)
2. Segmental Le Fort I osteotomy group (the minor segment only)
Preoperative and postoperative cephalograms were traced, and analyses of hard tissue, soft tissue, and the cheek line were done. On the cheek line,3 angular measurements were made: ∠C1, ∠C2, and ∠C3, in addition to the anteroposterior movement of the cheek line (C4, C5). ∠C1 is the angle made between the cheek line and a horizontal line located at the intermedi ate point between the FH plane and Pronasale. ∠C2 is the angle made between the cheek line and a horizontal line located below Subnasale.
The results were that, in both the complete and segmental maxillary osteotomy groups,
∠C1 tended to increase, while ∠C2 decreased, after two-jaw surgery.
In conclusion, the cheek line tends to become convex after t wo-jaw surgery in cleft lip and palate patients.

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The purpose of this study was to evaluate the effect of head position on activity of the levator veli palatini muscle, the major muscle involved in velopharyngeal closure, during speech in speakers with borderline velopharyngeal competence / incompetence ( BVP ). Five speakers with BVP were studied. Smoothed EMGs of the levator veli palatini muscle were respectively recorded in three head positions: In the first ( Condition-1), the head was in the flexed position; in the second ( Condition-2), the head was in the upright position, and in the third ( Condition-3), the head was in the extended position. The subjects produced the speech sample [pu] 10 times in each condition. Levator veli palatini muscle activity was not significantly different between Condition-1 and Condition-2. However, activity in Condition-3was significantly greater (p<0.01; t-test) than in Condition-1 and Condition-2. The results of this study suggest that velopharyngeal function is influenced by a change in head position. That is, the extended position may require greater activity of the levator muscleto close the velopharynx adequately.

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To improve techniques of primary cleft lip repair, it is necessary to clarify facial and maxillary deformities in infant with cleft lip and palate. The purpose of this study was to clarify whether the skeletal structure of maxillary deformities has an effect on the soft tissue facial deformities, and whether the type of the position and the degree of the cleft lip exists in untreated unilateral cleft lip and palate patients. Using a non-contact threedimensional digitizer, the authors measured and analyzed facial and maxillary plaster casts of 20 infants with complete unilateral cleft lip and palate, on the same axis of coordinates. The results were as follows.
The difference between the height of cleft side peak of the Cupid's bow on the medial and lateral segment shows the highest contribution with the maxillary elements. The position of the nasal tip shows the second highest contribution. The position of the frenulum of the upper lip, and the difference between the depth of the anterior end of the large segment and that of the small segment, have remarkable effects on cleft lip and nose deformities. The skeletal structure of maxillary deformities has an effect on the soft tissue facial deformities.
The distribution of the elements concerning the position and the degree of cleft lip is nearly normal.

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A presurgical orthopedic procedure was applied, before cheiloplasty, to 4 patients with complete unilateral cleft lip and palate,1 patient with incomplete bilateral cleft lip and palate, and 3 patients with complete bilateral cleft lip and palate. Two kinds of Latham appliances were used: the Dento-Maxillary Advancement appliance (DMA), and the Elastic Chain Premaxillary Repositioning appliance (ECPR). These appliances were examined in the Department of Plastic Surgery, Tokai University School of Medicine, from June 1998 to May 1999.
1. The DMA was applied to complete unilateral cleft lip and palate and incomplete bilateral cleft lip and palate patients, and it was activated in order to move maxillary components 0.5 mm a day.
1) Wide cleft defects were almost closed,2) the greater segment deviated over the midline, and the lesser collapsed segment, were positioned properly within a short period. Then the lesser segment and greater segment were brought together in a butt-joint shape, and the alveolar arch acquired a close symmetric form.
2. The ECPR, which used 90g of elastic chain power on both sides of the premaxillary segment, was applied to complete bilateral cleft lip and palate patients.1) The protruded premaxilla moved backward.2) Since cleft defects were almost closed on both sides, and/or collapsed maxillary segments were expanded laterally, the relationship of the premaxilla and maxillary segments were corrected to the normal position. Lateral cephalometric Xrays showed that Point A was significantly moved backward.

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In 1989, Double Opposing Z-plasty was introduced for isolated clefts of the soft palate at Chiba Children's Hospital. Since 1992, it has been used, with our modifications, for all types of clefts. We investigated the velopharyngeal function and articulation of patients, comparing the results obtained by each of double opposing Z-plasty and the Wardrill-Kilner procedure. Subjects were 39 patients undergoing double opposing Z-plasty (Furlow group), and 25 undergoing the Wardill-Kilner procedure (Wardill-Kilner group). All patients were operated on by a single surgeon. Velopharyngeal competence (VPC) and articulation were evaluated by the method of the Committee of Cleft Palate Speech, Japan Association of Logopedics and Phoniatrics. Most of the subjects were from 4 to 5 years of age at the time of evaluation. No systematic speech training was undertaken before evaluation. The results were as follows:
1.82.1% of the Furlow group had sufficient VPC, as compared with 76% of the Wardill-Kilner group. No statistically significant differences were evident between the two groups. When patients were categorized according to the cleft type, no significant statistical difference was found due to cleft type.
2.66.7% of the Furlow group had no articulation errors, while 48.0% of the Wardill-Kilner group had no articulation errors. No statistical difference was evident between the two groups. Among the patients with good VPC,75% of the Furlow group had no articulation errors, as opposed to 47.4% of the Wardill-Kilner group. The Z-plasty group was significantly superior to the Wardill-Kilner group in articulation (χ²=3.986, df=1, p<.05).
3. Among those patients,12.5% of the Furlow group had palatalized articulation, and 3.1%had lateral articulation. On the other hand,26.3% of the Wardill-Kilner group had palatalized articulation, and 31.6% had lateral articulation. Palatalized articulation and lateral articulation were found more frequently in the Wardill-Kilner group. It was assumed that better condition of the maxillary growth of the Furlow group had affected the result of articulation. In conclusion, the two groups revealed no significant difference regarding velopharyngeal competence. In addition, patients in the Furlow group were superior in articulation.

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Bone grafting to the alveolar cleft performed in the First Department of Oral and Maxillofacial Surgery, Tsurumi University Dental Hospital or its related clinics, between 1994and 1999, was clinicostatistically analyzed.
The following conclusions were obtained
(1) The total number of patients was 86. Twenty-two (25.6%) of the 86 patients were of ages 11 and younger,32 were of ages from 12 to 17 (37.2%), and 32 were of ages 18 and older (37.2%).
(2) The success rate of bone grafting was 97.7%. Early unsuccessful grafting occurred in 2adult patients. In adult patients, management of the teeth and periodontitis, which can induce infection in the bone grafting site, is important.
(3) Eighty (93.0%) of the 86 patients were referred from other clinics, for treatment of the alveolar cleft. In particular,72.5% of all the referred patients were sent by orthodontists. On the other hand,6 patients, who visited our clinic with complaints unrelated to the alveolar cleft, did not have any information about bone grafting to the alveolar cleft. Improvement of cooperation with other clinics and enlightenment of cleft lip and palate patients is necessary.
(4) Additional surgeries based on the bone grafting, such as orthognathic surgery, placement of a dental implant fixture, and secondary repair of cleft lip and nose deformity, were performed, mainly on adult patients. This situation suggests that alveolar bone grafting to adult patients is clinically significant.

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