The loss of epithelial cells by apoptosis was investigated in the fused area of the palatal shelves during secondary palate development in ICR mice. The results were as follows:
1) Sec ondary palate development, from palatal contact to fusion, was divided into five stages as follows:
(1) no palatal co ntact, (2) palatal contact, (3) early palatal fusion, (4) late palatal fusion, and (5) complete palatal fusion.
2) During the early and late palatal fusion stages, the morphological findings were as follows: reduced cell size, condensed chromatin, spreaded intercellular space caused by reduction in cell size, and apoptotic bodies.
3) The appearance of Fas and Fas ligand positive cells was marked during the early andlate palatal fusion phases, suggesting that apoptosis is mediated by Fas/Fas ligand.
4) The appearance of TUNEL positive cells, which exhibit DNA fragmentation, was marked during the early and late palatal fusion phases. However, cells with DNA fragmentation were not seen in the areas of disappearence of epithelial cells.
5) Shedding periderm, which has been seen in the nasal and oral cavities, is thought to be one of the mechanisms by which apoptotic cells are eliminated into the lumen.
6) Apoptosis was responsible for most of the epithelial cell loss in th e fused area during secondary palate development.

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Since July 1986, cleft lip and palate patients have been treated at our clinic through a multidisciplinary, team approach, and it has been attempted to operate on patients as early as possible. The first review of patients visiting our center for the first 7 years since then has been reported. In the present study, patients from July 1993 to June 1998 were reviewed to compare with the previous review, considering the factors preventing early repair of cleft lip. As a result, the proportion of early repair of cleft lip, done within 90 days after birth, increased. In bilateral cleft lip cases, all of the patients not undergoing early repair had significant complications, while in unilateral cleft lip cases,44% of the patients not undergoing early repair had some complications. Milder cleft unilateral cases tended to be repaired later.

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On 30 patients with congenital velopharyngeal incompetence (CVPI), the ratio of the length of the soft palate to the depth of the pharynx (soft palate/pharynx), mobility of the soft palate and lateral pharyngeal wall, occurrence of Passavant's ridge, articulation disorder, and mental development were investigated. The results were as follows:
1. There were few cases with the normal ratio of soft palate/pharynx and many cases with morphological imbalance among cases of congenital velopharyngeal incompetence.
2. Even in cases with the abnormal ratio of soft palate/pharynx in which almost no movement of the soft palate and lateral pharyngeal wall was observed, favorable closing function was obtained when nasopharyngeal morphology became adequate for closure after pharyngeal flap surgery.
3. Passavant's ridge occurred in cases in which the ratio of soft palate/pharynx was from border to abnormal and the mobility of the soft palate was above the moderate level. As a result, favorable closure was not obtained even when Passavant's ridge occurred. Judging from these results, it is considered that the morphological imba lance of epipharynx plays an important role in the occurrence of congenital velopharyngeal incompetence.
4. It was observed that glottal stop was the most frequent type of a rticulation disorder, followed by omission and weakness of consonants. Cases of palatalized articulation and pharyngeal stop were very rare.5. No obvious tendency was observed as to the relationship between the period for articulation improvement and the mental development.
6. The period required for articulation improvement was found to be only 9 months on average after favorable velopharyngeal function was obtained by pharyngeal flap surgery.

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The purpose of this study was to investigate the effects of two-stage palatoplasty combined with Hotz's plate on maxillary growth in patients with complete unilateral cleft lip and palate. The subjects selected for this study were 32 Japanese males who were divided into three different groups: The two-stage group consisted of 12 UCLP patients whose cleft palates were closed with two-stage palatoplasty (soft palate closure at 1 year and 6 months, followed by hard palate closure at 5 years and 11 months on an average); the one-stage group consisted of 10 UCLP patients whose cleft palates were closed with one-stage palatoplasty at 1 year and 1 month of age; and control group consisted of 10 noncleft subjects who had Class I normal occlusion. Plaster dental casts of each group (mean age: 12.5,12.8, and 12.3 years for two-stage, one-stage, and control groups, respectively) were examined. Nine measurements of dental arch width and 7 measurements of dental arch length were obtained, and the data from the three groups were compared by Student's t-test. Upper dental arches were significantly larger in the two-stage and control groups than in the one-stage group, and there were no significant differences between the two-stage and control groups except in the inter-canine distance. Only 3 of 12 subjects in the two-stage group had crossbite, while in the one-stage group, all 10 subjects had severe crossbite. The results in this study showed that maxillary growth up to permanent dentition in UCLP patients with two-stage palatoplasty combined with Hotz's plate was better than that in UCLP patients with one-stage palatoplasty, and was similar to that of subjects with normal occlusion, indicating that this procedure for palatal closure could be advantageous for maxillary growth.

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The non-verbal behavior (expressing of an idea, opinion, emotion, etc.) in patients with postsurgical cleft lip and palate (CLP) during interpersonal communication was analyzed by a physical motion analyzing method. A pair of twins, one of them with postsurgical CLP and the other without CLP, were evaluated.
A psychologist interviewed each of them on the sam e arranged topics for about 20 minutes. During the interviews, each subject was videotaped from the front and right side by two cameras. The movements of head and hand were measured by motion analyzing method.
(1)The sister with CLP showed fewer both head and hand movements than the sister without CLP.
(2) The sister without CLP enlarged the movement of head and hand gradually in process ofinterview. On the other hand the sister with CLP kept sitting up straight during the time.
These results suggest that this physical motion analyzing method prove the communi cative difference between these twins sisters. This method can be useful to get objective information about the non-verbal behavior in patients with cleft lip and palate.

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Numerous cleft lip and/or palate patients have congenital missing teeth in the alveolar cleft, so prosthodontic treatment is often necessary after orthodontic treatment. This case report presents orthodontic treatment of a mandibular protrusion patient with left unilateral cleft lip and palate, missing lateral incisors and right second premolar in the maxilla, reduced alveolar cleft by extracted mandibular first premolars and secondary bone grafting of the alveolar cleft to build a base of the nasal ala and close the alveolar cleft.
The patient was a female aged 7 years 6 months at initial examination. Th e chief complaints were crowding and cross bite. Most teeth demonstrated cross bite. She had SNA 66°, SNB 69.5°, ANB -3.5°, and FMA 27°, and her maxilla had a slight growth tendency.
Posterial cross bite was corrected by a fan type expansion plate and quad he lix. Then anterior cross bite was corrected by utility arches. In the permanent dentition, maxillary spaces and extracted mandibular first premolars spaces were closed and the alveolar cleft was reduced. Secondary bone grafting was performed to build a base of the nasal ala and close the alveolar cleft. Then maxillary cuspids were corrected to resemble lateral incisors. As a result, the patient was treated for occlusion without prosthodontic treatment.
By closing congenitally missing spaces of maxillary lateral incisors and extracted spaces of mandibular premolars, the lateral view of the face was corrected and occlusion was corrected without prosthodontic treatment. Secondary bone grafting at the base of the nasal ala and alveolar cleft was not difficult because the alveolar cleft was reduced.

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Secondary bone grafting into alveolar cleft has become a very popular procedure. At our department, alveoloplasty has been performed by transplanting cancellous bone from the ilium to the cleft maxilla in cooperation with the Orthodontic Department since 1994.However, sometimes it is difficult to prepare a graft bed of sufficient size for safe bone transplantation because of difficulty in closing the mucoperiosteum of the nasal cavity. If the mucoperiosteum of the cleft maxilla is dissected or damaged during surgery before bone grafting and so is not available for suturing over the graft bed, complications can occur. In such cases, artificial dermis has been used with favorable results. Our technique for using artificial dermis and some representative patients will be presented.
Operative procedure:The mucoperiosteum at the cleft is dissected so that it can be used to close the palatal and nasal cavity defects. However, in some patients, the mucoperiosteum on the median side (unaffected side) is absent, so that the nasal cavity defect cannot be completely closed. In such cases, a graft bed that had no fistula with the nasal cavity can be prepared by placing artificial dermis over the mucoperiosteal defect.
Postoperative complications included a fistula and bone gra ft resorption in one patient undergoing surgery using artificial dermis. This was probably because the patient had mental retardation and refused to rest appropriately. In three patients without artificial dermis grafts, fistulas also developed after surgery. These patients underwent treatment before artificial dermis was used to cover defects of the mucoperiosteum. Recently, artificial dermis has been used in all patients with mucoperiosteal defects, and the postoperative results have improved.
Artificial dermis is produced from bovine dermal collagen. It blocks communication between the bone graft bed and the nasal cavity, and it may also contribute to mucosal regeneration through gradual replacement by granulation tissue.
The use of artificial dermis caused no side effects such as infection or allergic reaction. This material has already been used in the field of oral surgery. In the field of plastic surgery, it has also been employed to cover dermal defects that cannot be treated by primary skin grafting and its usefulness has been demonstrated.
Whether the artificial dermis was replaced by mucoperiosteum after surgery and whether it promoted the development of mucosa could not be confirmed. However, this material was useful in patients with mucoperiosteal defects.

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