Journal of Japanese Cleft Palate Association
Online ISSN : 2186-5701
Print ISSN : 0386-5185
ISSN-L : 0386-5185
Volume 28, Issue 3
Displaying 1-9 of 9 articles from this issue
  • Hanako NUNOTA, Shuichi MORITA, Hideki YAMADA, Masaki TAKEYAMA, Kooji H ...
    2003 Volume 28 Issue 3 Pages 203-211
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    This study investigated the changes of soft tissue profile in the nose following Le Fort I osteotomy in unilateral cleft lip and palate patients. The subjects were 13 unilateral cleft lip and palate patients (9 females and 4 males) who underwent Le Fort I osteotomy (Cleft group). The Control group was skeletal Class III patients (19 females) who underwent two-jaw surgery without cleft lip and palate. For each patient, lateral cephalograms, taken preoperatively a nd postoperatively, were traced and superimposed, and linear and angular measurements were obtained. The alinasal width was measured on frontal facial photographs taken at pre- and post-operative stages.
    The results were as follows: 1. The maxilla of the Cleft g roup was in a more backward position than that of the Control group at the pre-operative stage.2. Dorsal nasal angle ( /1 ) of the Cleft group was smaller than that of the Control group.3. Basal nasal angle ( /2 ) of the Cleft group was larger than that of the Control g roup.4. Apex nasal angle ( /3 ) of the Cleft group was smaller than that of the Control group.5. The rate of horizontal subnasal changes to horizontal maxilla movement in the Cleft group was larger than that in the Control group.6. Alinasal width of the Cleft group wa s larger than that of the Control group in the preoperative stage, but the increment of alinasal width of the Cleft group after surgery was smaller than that of the Control group.
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  • Haruka TSUKADA, Hiroyuki ISHIKAWA, Kenji TAKATA, Hiromi TAKAGI, Junich ...
    2003 Volume 28 Issue 3 Pages 212-219
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    Some patients with unilateral cleft lip and palate who have undergone orthodontic treatment later require orthognathic surgery even if the anteroposterior discrepancies in the jaws seem to have been initially improved by control of jaw growth. This study investigated the craniofacial growth and development in such cases. Six male patients were treated by orthognathic surgery (surgical group) and 16 male patients were treated orthodontically alone (nonsurgical group). Longitudinal lateral cephalograms of the patients were examined. The following results were obtained.
    1) In patients in the s urgical group, anteroposterior discrepancies in the jaw were improved or at least prevented from deteriorating through orthopedic treatment, but excessive mandibular growth in the forward direction and deterioration of anteroposterior discrepancies in the jaws were noted in the pubertal growth period.
    2) Comparison of craniofacial gr owth and development in the surgical and nonsurgical groups showed that there was no obvious difference in extents of maxillary growth in the forward direction but that the extent of mandibular growth in the forward direction in the surgical group was much greater than that in the nonsurgical group. Significant body growth and forward rotation of the mandible were observed in the surgical group. These findings indicated that control of jaw growth in surgical cases was not effective for restricting mandibular forward growth.
    3) Comparison of th e initial values of craniofacial cephalometric variables in the surgical and nonsurgical groups did not reveal any significant differences that would enable these two groups to be distinguished.
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  • Enkhtuvshin GERELTZUL, Yoshiyuki BABA, Kimie OHYAMA
    2003 Volume 28 Issue 3 Pages 220-228
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    Objective: The aim of this study was to investigate the eruption pattern of the cleft side canine concerning its position before eruption to the cleft in secondary bone grafted and non-grafted patients with cleft lip and palate. Materials and methods: This study includes 22 canines in 21 patients, who had received secondary bone grafting before canine eruption,17 canines in 16 patients without bone grafting, and 31 canines in non-cleft side as controls. Totally 37 cleft lip and palate patients (70 canines) were examined using panoramic radiographs taken at two stages, before and after canine eruption. According to canine position relative to the cleft site at pre-eruption stage subjects were divided into two groups; I) close to the cleft site, and II) distant from the cleft site. Canine angle, measured between the major axis of the canine and a straight line through both the lowest points of orbital fossa, canine angle change between two stages, and alveolar bone height after its eruption were evaluated. Results: 1. No significant differences were found between initial canine angles of grafted and non-grafted groups, however control group showed significant high angle compared to grafted (p<0.05) and non-grafted samples (p<0.01).2. While canines in grafted group erupted without significant angle change, canine angle increased significantly in non-grafted (p<0.01)and control groups (p<0.0001) through eruption.3. In group I, greater canine angle change was found in non-grafted samples than in grafted samples (p<0.05). However, in group II significant difference was not found between non-grafted and grafted samples.4. Concerning the alveolar height of canine after eruption, significant difference was not found between grafted and non-grafted samples in both group I and II. Conclusion: These results suggest that canine located near to the cleft (group I) erupts with the same angulation as it had before grafting in grafted samples, however in non-grafted samples it erupts with more vertical direction, guided by cortical bone. On the other hand, canine distant from the cleft site (group II) erupts with the same angulation change in non-grafted and grafted samples.
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  • Yoshiyuki BABA, Eduardo Yugo SUZUKI, Yutaka KITAHARA, Michiko TSUJI, K ...
    2003 Volume 28 Issue 3 Pages 229-237
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    Objective: This study investigated the change and stability of maxilla through application of distraction osteogenesis using the RED System to patients with cleft lip and palate. Materials and methods: The cases used in this study were 8 cleft lip and palate patients, mean age of 13. 3 years, treated using the RED System at Tokyo Medical and Dental University Hospital. Maxillary movement during the distraction and follow-up periods was investigated, using lateral cephalograms taken before distraction, at the removal of halo, and more than 6 months after surgery. Results: 1. In horizontal dimension, mean maxillary advancement of 9. 4mm, ranged from 4. 0mm to 14. 5mm, was attained during distraction. During the follow-up period, relapse was observed in all cases and the mean amount was 2. 0mm indicating 21. 7% of advancement. A negative correlation was found between horizontal changes in the distraction and follow-up periods. 2. In vertical dimension, maxillary movement was upward in 1 case, downward in 6 cases, and not shown in 1 case during distraction, resulting in a mean amount of 2. 9mm downward. During the follow-up period, maxillary movement was upward in 2 cases, downward in 5 cases, and not shown in 1 case. However, a negative correlation was found between vertical changes in the distraction and follow-up periods, and changes in opposite directions between two periods were demonstrated in only 3 cases. 3. Clockwise and counterclockwise rotation of the palatal plane during the distraction period was observed in 4 cases, respectively, with mean angle of 1. 1 degrees clockwise. A negative correlation was found between rotation of the palatal plane in the distraction and follow-up periods. Conclusion: Distraction osteogenesis using the RED System was applied to patients with cleft lip and palate including growing children. A large maxillary advancement, mean of 9. 4mm, was attained, suggesting the clinical significance of this technique.
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  • Masaki FUJIMOTO, Kazuhiko YAMAMOTO, Masayoshi KAWAKAMI, Atsuhisa KAJIH ...
    2003 Volume 28 Issue 3 Pages 238-249
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    A clinico-statistical study was performed in 332 cases of cleft lip and palate in the past 20 years at the Department of Oral and Maxillofacial Surgery, Nara Medical University. The results were as follows: 1. The patients were 181 male s and 151 females, with a male to female ratio of 1.2: 1.2. Cleft morphology was classified as follows: cleft lip in 66 cases (19.9%), cleft lip and alveolus in 34 cases (10.2%), cleft lip and palate and/or alveolus in 127 cases (38.3%), cleft palate only in 69 cases (20.8%), submucous cleft palate only in 26 cases (7.8%), bifid uvula in 13 cases including cleft lip and/or alveolus in 4 cases.3. The laterality in clefts of lip, alveolus and p alate in 228 cases was unilateral in 178 cases (78.1%), bilateral in 49 cases (21.5%), and median in one case (0.4%). The laterality of these cases was the left side in 62.4%, and the right side in 37.6%, with a left to right side ratio of 1.7: 1.4. Familial occurrence was found in 18 of 281 families of the propositi (6.4%).5. Other congenital anomalies and/or disorders were found to be assoc iated in 41 cases (12.3%). Congenital heart diseases were most frequently seen in 14 cases (4.2%).6. Surgical treatments were performed in 215 cases,171 of 227 primary ca ses (75.3%) and 44of 105 secondary cases (41.9%). Surgical procedures were cheiloplasty in 127 cases, palatoplasty in 101 cases, secondary bone grafting for the alveolar cleft in 26 cases, and rhinoplasty in 22cases.
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  • Miho YUKI, Toshitsugu KAWATA, Kotaro TANIMOTO, Yoshihiro MIYAMOTO, Kaz ...
    2003 Volume 28 Issue 3 Pages 250-260
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    This study investigated the clinical application of guided bone regeneration (GBR)for alveolar bone defect in a patient with cleft lip and alveolus. A bioresorbable, lactic acid/glycolic acid copolymer membrane barrier was used. Three weeks after the application of the GBR technique,0.018 X 0.025-inch standard edgewise appliances were used for the subsequent orthodontic treatment. A bone bridge was formed at the alveolar bone defect, and the alveolar bone height and width increased during the post-operative observation period. These results suggest that the GBR technique is applicable to alveolar bone defects in cleft lip / palate patients, provided the mucoperiosteal flaps are handled carefully and good anti-infective therapy is performed to prevent early exposure and microbial contamination of the membrane barrier. Key words: cleft lip and alveolus, alveolar cleft, GBR, alveolar bone regeneration, bone graft
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  • Naoyuki MATSUMOTO, Toshihiro NOBATA, Takuji IIDA, Takuji OHYA, Junnosu ...
    2003 Volume 28 Issue 3 Pages 261-270
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    This study observed craniofacial growth and evaluated the results of the treatment of median cleft lip and palate longitudinally. A case, a six-year-old girl with median cleft lip and palate, was treated orthodontically. Morphologic features of craniofacial skeleton and occlusion and the changes during treatment are presented in this report. The findings were as follows: 1. The maxilla was located po sterior and the maxillary dental arch was narrow, associated with anterior cross bite. The maxillary incisors adjacent to the median alveolar cleft showed mesial inclination and rotation.2. Orthodontic treatme nt was performed with an expansion appliance in the first stage, with an orthopedic appliance in the second stage and with a multi-bracket appliance in the third stage.3. A fter orthodontic treatment, the anteroposterior relationship between the maxilla and mandible remained skeletal Class III and the occlusal relationship was stable.4 After retention, relapse was not found These findings suggest that the use of a maxillary protractor and mandibular retractor controlled mandibular growth and kept skeletal proportional balances with median cleft lip and palate
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  • Yukie KOZAKI, Hidemi YOSHIMASU, Yutaka SATO, Hidetaka MIYAZAKI, Toru M ...
    2003 Volume 28 Issue 3 Pages 271-276
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    Larsen syndrome is a rare hereditary disease (autosomal dominant or recessive mode of transmission) characterized by the association of congenital multiple dislocations of large joints, flattened and depressed nasal bridge, and hypertelorism. Cleft palate is observed in 30-50% of this syndrome. In this paper, a case of Larsen syndrome with cleft palate is reported. A one-month-old female infant with cleft palate visited our clinic. As this patient had several severe constitutional symptoms with respect to this syndrome, multidisciplinary care was essential, and the timing of each treatment had to be carefully considered. As the general condition was steady at age 8, long-term oral surgical treatment and speech therapy started. Although this patient had been using a tracheal canula since age 1, she could speak by closing the end of the tracheal canula with her fingers, therefore palatoplasty was performed for treatment of velopharyngeal incompetence. Hypernasality and consonantal nasalization have tended to improve after the operation. This case suggests that careful consideration on the timing of treatment, pre- and postoperative control, and collaboration with other departments is important for the treatment of a patient with severe accessory symptoms such as this case.
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  • Yuri FUJIWARA, Noriko AINODA
    2003 Volume 28 Issue 3 Pages 277-279
    Published: October 30, 2003
    Released on J-STAGE: February 19, 2013
    JOURNAL FREE ACCESS
    We reviewed cleft palate speech evaluative systems which have been commonly used in the U. S. and Europe as well as in Japan, and initiated an international movement toward developing a universal standard. Japanese professionals should keep up with this global trend in order to deliver the best services to patients.
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