We investigated the relationship between velopharyngeal form and postoperative velopharyngeal function in 50 patients with cleft palates (14 patients with bilateral cleft lip and palate,21 patients with unilateral cleft lip and palate, and 15 patients with cleft palate). Palatoplasty was performed at the age of 1.5±0.1 years by push back method. Velopharyngeal form was evaluated by direct measurement just after the palatoplasty and lateral cephalograms which were taken just before the palatoplasty and at the age of 5 years. Postoperative velopharyngeal function was evaluated at the age of 5 years, and classified as adequate, slightly inadequate, and inadequate. The results were as follows:
1. No significant difference in the values of velopharyngeal forms was detected among the three groups of velopharyngeal function when the velopharyngeal forms were measured directly just after the palatoplasty.
2. In cephalograms w hich were taken just before the palatoplasty, there was no significant difference in the velopharyngeal form among the three groups of velopharyngeal function.
3. In cephalograms which were taken at the age of 5 years, the length of soft p alate in the inadequate group of velopharyngeal function was significantly shorter than that in the slightly inadequate and adequate groups of velopharyngeal function.
4. These results suggest that velopharyngeal incom petent may be caused by the inferior growth of the soft palate in the growing process after palatoplasty.

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The purpose of this study is to evaluate the postoperative results of the cleft nose reflecting the subjective perception by fuzzy theory.
Fifty-two Japanese unilateral cleft lip and/ or palate patients who underwent primary cheiloplasty at Kyusyu University Dental Hospital were the subjects. Facial pictures which were taken before and at least 6 months after the operation were studied. One oral surgeon was asked to evaluate each picture based on his subjective perception according to the evaluation form. This form was originally made for the evaluation of nose and included 5items to evaluate nasal morphology: (1) alar base, (2) nasal tip, (3) margin of nostril, (4)nostril, and (5) columella. Overall subjective evaluation was performed on the 5 items, and calculated VAS (Visual analogue scale) score in 100 points on VAS, and calculated VAS improvement score. On fuzzy analysis, point of each item was transformed into three different categories: “good,” “medium,” or “poor,” and from these data the fuzzy improvement score was determined.
The VAS improv ement score showed 33.9-38.4 with the average of 36.3 points. There was a tendency that the severe the nose deformity, the higher the improvement score. Fuzzy improvement score showed 64.1-67.0 with the average of 65.9 points reflecting the evaluator's subjectivity.
Our expert esthetic evaluation system expressed the rater subjective evaluation numerically and enabled the synthetic judgement of the postoperative result of the nose reflecting subjective perceptions.

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Nasometric characteristics based on Japanese syllables of vowels, [p] and [b] were clarified among 8 adults in Kansai (the mid-western part of Japan) dialect speakers. The results revealed that Mean N (nasalance) and Mean min-N in vowels showed higher value than those in consonants, and that Mean max-N in voiced consonants showed higher value than those in vowels and voiceless consonants. Thus, the orders of Mean N according to each of the vowels were, [i]>[a] = [e]>[_??_] = [o], /p/: [pi]>[pa] = [pe]>[p_??_] = [po], and/b/: [bi]>[be]>[ba] = [b_??_m]>[bo]> [bo]. These findings suggested that involvement of /o/and /_??_/ rather than voiced consonants and /i/ are the factors of recommendation for nasometric speech samples in Japanese. With these recommendations, LP (low pressure sentence) and HP (high pressure sentence) speech samples in Japanese were proposed as follows:
⋅LP sentences [meo o: _??_] [jo: iwa o: i]
⋅HP sentences [kotsulkots_??_ ts_??_k-Lus_??_] [kits_??_ts_??_ki ts_??_ ts_??_k_??_]The feasibility trials for these samples were made amo ng the groups of Normals (10adults), BVP (7 children with borderline velopharyngeal incompetence/competence) and VPI (13 children with velopharyngeal incompetence) in patients with cleft palate. The results revealed that both of the LP and HP speech samples could make discrimination among the groups of Normals, BVP and VPI when nasalance components of Mean N, Mean max-N and Mean min-N could be compared through ANOVA analysis. It is recommended that the Japanese LP and LP speech samples described here be used as an appropriate evaluation approach for identifying patients with velopharyngeal incompetence following cleft palate surgery.

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The Goslon Yardstick is a clinical tool that allows categorization of the dental arch relationships in patients with unilateral cleft lip and palate (UCLP) into five groups (group 1-excellent, group 2-good, group 3-fair, group 4-poor, group 5-very poor). This categorization has been used as an index of the occlusion in the European comparative cross-centre studies, and in other studies worldwide.
In this preliminary study, the Goslon Yardstick was applied to 25 Japanese UCLP patients who were reviewed in the University of Tokyo Hopital (UT). The assessment was carried out before orthodontic treatment at the mean age of eight years five months. Since the compatibility with the original method was considered important, the assessment was performed in the United Kingdom. Although dental models are used in the original Goslon Yardstick, intraoral photographs (frontal, right and left lateral views and maxillary occlusal views) were used in this study, thereby eliminating the need to transport heavy and fragile records. The results were compared with the previously reported European centres. While recognising that there are some limitations of photographs compared to models, the following findings were obtained from this study.
1) The Goslon Yardstick was considered to be useful for the assessment of the occlusion in UCLP patients.
2) The results of the 25 patients in UT were distributed as follows: group 1: no case, group 2; two cases, group 3; eight cases, group 4; twelve cases, group 5; three cases. Poor and very poor groups (4 and 5) comprised 60 percent of the patients.
3) The Japanese results demonstrate worse surgical t reatment outcomes than any of the European centres. Clearly, further investigation of treatment outcome in Japan needs to be undertaken.

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The speech results in 135 primary cases of cleft lip and palate, treated at our clinic (Oral Surgery II) between April 1981 and December 1996, were evaluated, at the age of 4years, and the effect of a Hotz plate for speech improvement was investigated. The subjects consisted of 70 patients (42 UCLPs and 28 BCLPs) with Hotz plates, as the HP group, and 65patients (48 UCLPs and 17 BCLPs) without Hotz plates, as the non-HP group. All the repair by the pushback method, and speech training at our clinic. Velopharyngeal closure (VPC), speech articulation of plosives ( / p/, i k/ /t/ ), and articulation disorders were evaluated, at the age of 4 years. The results were compared between the two groups.
The results were as follows:
1. At the age of 4 years,12 4 (91.9%) of 135 patients had acquired VPC. The patients with VPC accounted for 94.3% of the HP group and 89.2% of the non-HP group. The patients with HP had acquired VPC at the age of 847 days and those without HP at 866 days. There was no significant difference between the two groups. Patients who had acquired /p/ articulation accounted for 97.1 % of the HP group and 93.8%of the non-HP group, those who had acquired /k/ articulation accounted for 92.9% of the HP group and 93.8% of the non-HP group, those who had acquired It/ articulation accounted for 82.9% of the HP group and 76.9% of the non-HP group. Patients in both groups had acquired the articulation of /p/ first, followed by /k/ and /t/. UCLP with HP had acquired /k/significantly earlier than those without HP.
2. Articulation disorders were observed in 53 (39.3%) of 135 patients at the age of 4 years. Palatalized articulation was observed most frequently, followed by glottal stop. Articulation disorders were observed in 24 (34.3%) of 70 patients in the HP group, and in 29 (44.6%) of 65in the non-HP group.
3. To exclude influence of the age difference at palate repair, only subjects that had subjects at the age of 17-19 months were selected, and the speech results were compared between two groups of with HP and without HP. There was no significant difference observed between the two groups. It was suggested that the Hotz plate had no effect on speech improvement.

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Goslon Yardstick is regarded as a reliable method that is useful for evaluating the malocclusion in patients with unilateral cleft lip and palate and used for retrospective comparative study among European cleft centers in recent years. In this study, we applied Goslon Yardstick to Japanese patients with unilateral cleft lip and palate, and investigated the reproducibility of this method and the factors which correlated with the results of the evaluation. The study models of 37 Japanese patients with unilateral cleft lip and palate in the Department of Orthodontics, School of Dentistry, University of Tokushima, were used in this study. Four experienced orthodontists independently graded 37 cases into five groups twice at an interval of one week; i, e, group 1 (excellent), group 2 (good), group 3 (fair), group 4 (poor), group 5 (very poor). The reproducibility of the Goslon scores were judged by Spearman's rank correlation coefficient. The correlation between the Goslon scores and the overbite and overjet of incisors, canines and first molars were determined as significant by the regression analysis and Spearman's rank correlation coefficient. The mean value of the Goslon scores for 37 cases (group 1: 1 case, group 2: 4 cases, group 3: 15 cases, group 4: 13cases and group 5: 4 cases) were 3.41±0.61. The intra-and interexaminers' Goslon score reproducibility was acceptably high. Goodness-of-fit of the simple regression analysis between the Goslon scores and the overjet of incisors were statistically significant (P<0.01). Selected parameters for the multiple regression analysis with the stepwise method were the overjet of incisors (P<0.01) and the overjet of canine of lesser segment (P<0.05). A significan t negative correlation by means of Spearman's rank correlation coefficient was observed between Goslon score and the overjet of incisors (P<0.01) as well as the overjet of canine of lesser segment (P<0.05).
The results of the present study suggest that the Goslon Yardstick is reliable and useful even in the evaluation of malocclusion in Japanese patients with unilateral cleft lip and palate.

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Orthodontic space closure of a cleft in the maxillary arch without prosthetic rehabilitation has been enabled by secondary bone grafting. It is easily achieved when the canine has not fully erupted at the time of bone grafting. However, not a few bone grafting procedures must be performed after the canine has erupted. The aim of this research was to investigate the outcome of dental occlusion in patients with bone-grafted alveolar clefts. Subjects were 88 patients who underwent secondary bone grafting, in our department, from 1987 to 1998, and they were divided into two groups, of the canine not fully erupted, and fully erupted, at the time of surgery. The numbers of the various types of clefts are as follows: 28cases of cleft of the lip and alveolus (unilateral,26; bilateral,2); 60 cases of cleft of the lip and palate (unilateral,52; bilateral,8). Of the total of 99 clefts,51 were in the group of the canine not fully erupted, and 48 were in that of fully erupted. Dental occlusion was classified into nine categories as follows: orthodontic space closure with the canine or the lateral incisor (C), space closure with restoration of the dwarf lateral incisor (Cr), bridgework (B), partial denture (D), autotransplantation of a tooth (T), application of an implant (I), no prosthetic treatment (N), unknown (U), and under orthodontic treatment or observation (O). In the group of the canine not fully erupted, the outcome of dental occlusion was as follows: C,28; Cr,2; B,1; T,1; N,1; U,2, and 0,16 cases. In the group of the canine fully erupted, the outcome of dental occlusion was as follows C,22; Cr,1; B,14; D,1; T,3; I,1; N,2; U,2, and 0,2 cases. According to the types of clefts, the major dental occlusion in patients with unilateral and bilateral cleft lip and alveolus and unilateral cleft lip and palate, was C, while it was B for bilateral cleft lip and palate. Non-prosthetic space closure (categories C, Cr, T, I) was accomplished in 61% of cleft sites in which the canine was not fully erupted at surgery, and in 52% of cleft sites in which the canine was fully erupted at surgery. Orthodontic space closure without prosthetic rehabilitation was the major procedure in both groups. In particular, in the not fully eruption group, the prospect that cases of category Oare likely to move into category C will result in the achievement of space closure in 92% of cleft sites, sustaining the clinical significance of bone grafting before the canine eruption. Bridgework was the second major procedure in the canine fully eruption group, as well as in bilateral cleft lip and palate patients. Desirably, a primary goal in the canine fully eruption group is also achieving orthodontic closure of the cleft space, or the application of tooth autotransplantation and dental implant to bone-grafted alveolar clefts, without prosthetic rehabilitation.

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Secondary cancellous bone grafting has become a very popular procedure in the treatment of alveolar cleft. However, there are some cases which are difficult to cover the entire graft-bed with a periosteum. Among those cases, some had the alveolar cleft closed at the time of the first cleft lip operation, the others needed incisions of the periosteum to decrease a tension of alveolar mucoperiosteum, which caused periosteal defect. Several reasons are considered to cause bony absorption postoperatively. It is considered that a lack of the periosteum surrounding the grafted bone is a high risk of bony absorption. Thus when harvesting an iliac cancellous bone, a free periosteum was taken simultaneously and grafted to the region lacking of the periosteum. This treatment was performed on eight patients (five males, three females). One patient lost grafted bone completely due to dehiscence of the alveolar wound postoperatively. The other seven patients had almost good bony formation according to three-dimensional computed tomography. The free iliac periosteum graft was considered useful in cases lacking the periosteum in the grafted bed.

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EEC syndrome is characterized by ectrodactyly, ectodermal dysplasia, cleft lip and palate.
Recently, a case of EEC syndrome accompanied with pathypopituitary, bilateral hydronephrosis and megalo ureter was encountered at our hospital.
Deficiency of kidney function was observed for 1 month because of stenosis of the ureterovesical transmigration and inappropriate secretion of antidiuretic hormone. When bilateral cheiloplasty was performed, careful control of water and electrolyte was prepared. At the perioperation of palate plasty, there was no noticeable trouble. The operation was successful, and there were no complications.

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A rare case of a deletion of the short arm of chromosome 9 (46, XX, del(9) (qter→p22: ) ) patient with cleft palate was reported. She was 2 years and one month old, and had a distinctive prominent forehead, flat occiput, up slanting palpebral fissures, flat nose with anteroverted nostrils, long philtrum, low set ears, and cleft palate. In the lateral cephalogram, it was revealed that the length of S-Ba and N-Ba, and the vertical distance between Or and S-N were significantly smaller than those of asyndromic cleft palate infants at the age of 2 years and one month. These values, however, were improved by the age of 7years, while a Cd-Go-Me angle grew significantly larger.

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Three-dimensional deformities of the premaxilla are often found in patients with bilateral cleft lip and palate (BCLP). In many of these cases, a floating premaxilla and an excessive overbite are associated with malocclusion. In such cases, it is difficult to establish occlusion solely by orthodontic treatment.
In this case, two-stage expansion of a maxillary collapsed dental arch was performed before and after bilateral simultaneous bone grafting. Movement of the bilateral upper canines was achieved by orthodontic treatment following the alveolar bone grafting. Bite raising was carried out in accordance with the uprighting and depression of mandibular molars and the extrusion of maxillary molars. As a result of these treatment steps, the patients facial profile was improved and occlusion was stabilized, to his great satisfaction.

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We report a case of right cleft lip and palate accompanied by congenital missing teeth of a lateral incisor and several premolars, in which occlusal reconstruction was accomplished without prosthetics but by use of autotransplantation and orthodontic treatment.
Case: A young female with rCLP who had congenital absence of 542 5. She had an operation on her lip by the Davies' at 4 months after birth, and her palate by the Manchester's at the age of 1y 5 m, and she had her first orthodontical examination at the age of four. According to the long-term treatment plan for her, illiac bonegrafting to the alveolar cleft site was carried out, at the age of eight, followed by autotransplantation of lower first premolars to the spaces of missing teeth, after alignment of the adjacent canine to the reconstructed alveorus, at the ages of 11 and 13.
Although she is under observation after occlusal reconstruction even now, the convalescence seems agreeable.
In this case non-prosthetic reconstruction was possible for all missing parts, including the teeth around the cleft. However, prolonged use of a fixed orthodontic appliance and numerous surgical operations are indispensable to achieve a non-prosthetic reconstruction.

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A clinical and statistical survey was carried out to investigate the patients with cleft lip and/or palate in the Department of Orthodontics, Showa University Dental Hospital, during the 21 years from 1977 through 1997.
1. The number of new patients increased y early until 1983, and reached a plateau thereafter, although there was a peak of the number in 1989.
2. The average age of the patients at the first vis it, at the first oral examination, and at the beginning of active treatment, were 7Y6M,7ylOM, and 9Y6M, respectively. All of these average ages have become younger, recently, and the number of patients at the first oral examination with a Hellman's dental age of 11A has increased.
3. The frequency and variation of cleft type were CLP>CP>CLA>CL. The number of CLP decreased, while that of CP increased, during the 21 years. The female/male ratios were 0.9 in CL,1.1 in CLA,0.7 in CLP, and 2.1 in CP. The left/right ratios within the unilateral CL, CLA, and CLP were all 1.9.
4. The frequency of the first a ppliance for active orthodontic treatment were expander>maxi llary protractor>chin cap. The frequency of expander and chin cap decreased, while that of the protractor increased, during the 21 years.
5. More than one-third of the patients lived in Tokyo, and the rate of the patients in Tokyo increased, while that of the patients within the neighboring 4 wards (Ohta, Setagaya, Meguro, and Shinagawa) decreased, during the 21 years.
6. More than three quarters patients were refer red from three departments (plastic surgery, pedodontics, and oral surgery) at Showa University, and the rate increased.

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