Postoperative results for particulate cancellous bone and marrow (PCBM) graft to alveolar clefts were analyzed by dental radiographs which were taken 6 months after the operation, in 83 alveolar clefts of 68 patients (20 unilateral cleft lip and alveolus,8 bilateral cleft lip and alveolus,26 unilateral cleft lip and palate, and 29 bilateral cleft lip and palate). Bone formation was obtained in 92.8% of alveolar clefts, and vertical bone formation of more than half the root length of the medially adjacent tooth was obtained in 69.9% of alveolar clefts. The vertical bone formation was worse in bilateral cleft lip and palate patients. Furthermore, the formation was significantly worse when the patient was over 14 years old, when the width of alveolar cleft was wider than 10 mm, or when the average size of oro-nasal fistula was larger than 5 mm in diameter. Eruption of the canine beside the alveolar cleft did not affect the bone formation. The canine beside the alveolar cleft could be moved to the cleft after the PCBM graft, when the vertical bone formation was obtained over half the root length of the adjacent tooth. On the other hand, canines could not always be moved when the height of the bone formation was less than half the root length of the adjacent tooth. These results suggest that vertical bone formation by PCBM graft is affe cted by the type of cleft, age of bone grafting, width of alveolar cleft, and size of oro-nasal fistula. Furthermore, vertical bone formation of more than half the root length of the adjacent tooth may be needed for reliable canine movement into the alveolar cleft.

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Objective: The aim of this study was to establish diagnostic criteria for velopharyngeal closure function (VPF) using the nasometer test in patients with cleft palate. Study design: Eighty-three patients who had been treated by palatoplasty and followe d up for more than thrae years, and twenty normal children as controls participated in this study. VPF was evaluated by perceptual voice analysis, blowing ratio and cephalometric analysis. The nasometer test was performed during vowel/i: /and consonant/tsm/phonation and during high-pressure and low-pressure sentences. The average and maximum nasalance scores were calculated. The relationship between these nasalance scores and the various VPF levels were analyzed for both cleft and control groups.
Results: VPF was evaluated as goo d in 28.9%, marginal in 18.1%, mild in 27.7%, and poor in 25.3% of patients with cleft palate. The nasalance scores during/i/phonation in the good VPF and control groups averaged 20%, and were significantly lower than the scores obtained by other VPF groups. The poorer groups obtained higher nasalance scores. Furthermore, the distribution of nasalance scores obtained while speaking about topics, revealed that the average nasalance score of the good VPF and control groups tended to be smaller than 20%when phonating vowels, consonants, and sentences, Conversely, many of the patients in the mild and poor VPF groups obtained nasalance scores of more than 40% on phonating vowels and consonants, with a maximum nasalance score of over 80%, when phonating high-pressure sentences.
Conclusions: We concluded that the nasometer test is useful for the objective assessment of postoperative VPF in patients with cleft palate. The test needs various high -and lowpressure conditions during the phonation of vowels, consonants and sentences. In this test, good VPF can be diagnosed when the average score of vowel is less than 20% and less than 60% during the phonation of low-pressure sentences. While poor VPF is indicated when the average score of vowel and consonant phonation is more than 40% and exceeds 80% during the phonation of high-pressure sentences. In these patients, active speech therapy should be followed.

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There appear to be fewer abnormalities in the bony development of the upper jaw in patients who have cleft lip without cleft alveolar, hard or soft palate, and special care does not appear to be necessary. However, we have observed bone defects or bone deformity and asymmetry of the piriform aperture among patients undergoing long-term follow-up fa. r cleft lip without cleft hard or soft palate. There were six patients, two male and four female. Five patients had a right-sided cleft lip and one had a left-sided cleft lip. All patients were diagnosed as cleft lip, but no evidence of cleft palate was found. On three-dimensional CT scans taken at 5 to 17 years of age, deformity of the piriform aperture was observed. Auto logous bone grafting was performed in two of the patients and an artificial bone substitute was used in another two patients. Two patients did not undergo any treatment of the bony abnormality. In patient s who have unilateral cleft lip without cleft palate, we have found that good development of the external nose is often impossible even when the nasal cartilage has developed and the recess at the base of the ala nasae is repaired. However, when attention is also paid to the shape of the piriform aperture and deformity is found in the hard tissue that supports the nasal cartilage, it is important to improve its morphology by inserting autologous or artificial bone grafts.

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An electromyographic study was carried out on the upper lip movement of unilateral cleft lip and palate patients during nursing before and after lip repair. The subjects consisted of 9 unilateral cleft lip and palate patients (UCLP group),6unilateral cleft lip patients (UCL goup) and 8 normal babies (normal group). Two pairs of surface electrodes measuring 8 mm in diameter were atta ched on both the cleft side and non cleft side of the upper lip. EMG activity during bottle feeding was measured preoperatively and 1 month and 3 months following lip repair in the patient groups and at the ages of 4 months and 7 months in normal babies, corresponding to the age in the patient groups preoperatively and 3 months following surgery. The oppressive pressure in the nipple of the nursing bottle (intra-nipple pressure) and the intra oral negative pressure due to sucking (intra-oral pressure) were measured simultaneously. The results were as follows:
1. Preoperatively, peak EMG and total EMG of the UCLP group were significantly lower than those of the normal group, and those on the cleft side were significantly lower than those of the non cleft side. Following surgery, peak EMG and total EMG on both sides increased significantly. Three months following surgery, the peak EMG on both sides increased nearly to the level in the normal group, but the total EMG of the cleft side remained significantly lower than that of the normal group.
2. In the UCL group, the pea k EMG and total EMG of both sides tended to be lower than those of the normal group but there was no significant difference between the two groups. Following surgery, those values on both sides increased significantly, becoming close to the level in the normal group.
3. Preoperatively, the cycle time and rhythms of oppressive pressure in the UCLP group and UCL group resembled those in the normal group and did not change following surgery. Peak EMG time on the cleft side in the UCLP group occurred significantly later than in the normal group, but following surgery, it repidly became nearly equal to that in the normal group. Peak EMG time in the UCL goup was nearly the level of the normal group before and after surgery. Key words: cleft lip and palate, electromyography, lip repair, orbicularis oris muscle, nursing

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Maxillary collapse in patients with repaired unilateral cleft lip and palate (UCLP)is known to easily relapse. To compare the relapse sequence in different types of maxillary collapse, relapse rates were examined. The subjects were 20 repaired unilateral CLP patients with lateral uni-or bilateral crossbite. The maxillary dental arch was laterally expanded with a quad-helix (QH) appliance at the mixed dentition and followed for at least two years. The maxillary arch forms were classified as type A (small but symmetrical), type B (collapse of minor segment) and type C (collapse of both segments). The dental and alveolar arch widths were measured at the first deciduous molar region (CD and BD) and those at the first molar region (C6 and B6) on the dental models taken before the expansion, at the removal of QH and after the removal of QR.
The relapse rates of CD and BD were 23.5% to 80.0% at one year after the removal of QH,33.4% to 80.0% at two years after the removal of QH in typeA, and 3.4% to 100% at one year,37.9% to 100% at two years in types B and C. On the contrary, the relapse rates of C6 and B6 were below 0 % to 46.5% at one and two years after the removal of QH in type A. But they were 30.4% to 100% at one year,42.7% to 100% at two years in type B,68.4% to 100% at two years in type C. These findings indicated that the maximum relapse rates of CD and BD in type A were 80.0%, in types B and C were 100%. The maximum relapse rates of C6 and B6in type A were 46.5%, but in types B and C were 100%. Key words: unilateral cleft lip and palate, collapse of maxillary dental arch, lateral expansion, relapse process

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The purpose of this study was to develop a method for measuring nasal configuration in cleft lip patients. In addition, we attempted to clarify the characteristics of cleft lip nose deformity and to evaluate the results of rhinoplasty by cartilage transplantation, which has been performed in our clinic as a secondary procedure to correct residual deformity of cleft lip nose in adults. The nasal morphology of 6 females with unilateral cleft lip and palate who under went rhinoplasty in our clinic at an average age of 17.1 years old was measured and analyzed preoperatively,1 month, and 1 year postoperatively with a three-dimensional measuring apparatus (Voxeran NKV-300DS). Ten normal females with a mean age of 19.1 years old were selected as a normal group. The results were as follows:
1. Prior to surgery, the co lumellar base was situated closer to the midline and more posteriorly than in the normal group, and the nasal apex was significantly deviated to the normal side. The nasal ala of the cleft side was situated more medially and lower than that of the normal side. The distance between the nasal alae was greater than that in the normal group. Following surgery, the nasal apex was elevated and moved into the midline. Slight relapse toward the normal side was observed 1 year postoperatively. No remarkable changes in the position of the nasal alae or the columellar base were observed postoperatively.
2. Prior to surgery, the nasal volume on the cleft side was signi ficantly larger than that on the normal side. The total nasal volume was smaller than that in the normal group. Following surgery, the nasal volume on both sides became almost equal, and the asymmetry of the nose improved.
3. Prior to surgery, the cross section area of the nose on the cleft side was larger than on the normal side. Following surgery, the total cross section area was significantly larger than that of the normal group.
4. It was confirm ed that the nasal deformity was corrected and remained symmetrical following the surgical procedure of rhinoplasty employed in our clinic. It was proven that the analysis method developed in this study using a three-dimensional measuring apparatus was useful for evaluating the nasal configuration.

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A clinico-statistical investigation was carried out on 765 patients with cleft lip and/or palate at the Department of Oral and Maxillofocial Surgery, School of Medicine, University of the Ryukyus during the 16-year period from 1985 to 2000.1. There were 416 males and 349 females, with a male to female ratio of 1.2: 1.2. Cleft morphology was classified as follows: cleft lip only and/ or alveolus in 235(30.7%), cleft lip and palate and/or alveolus in 312 (40.2%), and cleft palate only in 206(26.9%).3. The total number of operations related to cleft lip and/or palate was 1,165 during the 16-year period from 1985 to 2000.4. Four hundred thirty-eight patients had received cheiloplasty,338 patients had received palatoplasty,309 patients had received lip correction,67 patients had received alveolar bone grafting, and 13 patients had received other methods.

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