There has been few investigations about the distributions and the change of cell number of indigenous nasal microbiota in relation to palate plasty of cleft palate.
This paper deals with the ecolo g ical study of the distribution and the change of cell number of microbiota in the nasal cavity, on the dorsum of the tongue- and buccal mucous membrane in connection with palate plasty.
It seems to be one of the various factors that exert influence on nasal and oral microbial flora. Subjects studied consisted of 28 patients with complete palatal clefts, taking palate plasty from 1 year 2 months to 1 year 4months.
This experiments have produced the following results.
1) Before operation, the nasal flora resembled to the oral microbial flora but the aerobic organisms became predominant in place of obligatory or facultative anaerobic organisms, after operation it was silimar to normal nasal flora.
2) There was a similarity in oral microbial flora between the patients with palatal clefts and normal ones. But the former's got. much closer to the normal oral flora after operation, the cell number showed little change.
3) The cell number of streptococci was the most predominant either before or after operation in nasal and oral cavity, however, the number of Staphylococcus aureus was the lowest. Therefore, the author thought that we ought to take into account the above mentioned facts in order to prevent the infection during pre- and post-operation.

View full abstract

The nasopharyngeal organs in motion during phonation, blowing, sucking and swallowing was studied by lateral videofluorography in 25 normals. The results are summarized as follows.
1) The maximum elevation of the soft palate occurre d in swallowing, with less movement in blowing and even 1-ss in phonation. The movement in phonation was the greatest degree in consonants, then came vowels and nasal consonant s. Among the 5 vowels, /u/ showed the highest elevation of the soft palate with lesser movement in /i/, /e/, /o/ an d / a/ in that order.
2) In the majority of cases, nasopharyngeal closure was complete during the above activity except in sucking and in phonation of nasal consonants, but there are some in which the nasopharyngeal space was not completely closed during pho n ation of /a/and /o/. Significant differences were found in the amount of nasopharyngeal openings seen with the organs at a restin g position, upon sucking and during phonation of nasal consonants and /a/.
3) Movement of the posterior pharyngeal wall could be grossly divided into a flat type (20 cases) and a bulgy type (5 cases). The Passavant's ridge was observed in no case.
4) When classified according to the interrelationships of the soft palate and posterior wall movements, there were three different types in the nasopharyngeal closure during phonation. In Type I ( 13 cases), movements of the superior and u pper median pharynx was correlating to that of the soft palate. In Types II (8 cases) and III (4 cases), the soft palate actio n was accompanied by the movements of the upper median p harynx and the superior pharynx, respectively.
5) Motion of the nasopharyngeal structures upon blowing was relatively marked, but showed more or less similar pattern to that seen during phonation.
6) In sucking, the nasopharynx was left open and the soft palate was kept in close contact with the tongue.
7) Upon swallowing, nasopharyngeal closure was first attained by elevation of the soft palate and barium was swallowed down into the pharynx, then it was carried further down to the inferior pharynx with the aid of the tongue action.

View full abstract

The main purpose of this study was to substantiate a hypothesis that any differences should exists in craniofacial morphology between parants of children with cleft lip and palate and non-cleft adults.118 lateral cephalometric roentgenograms from 30parents each of male and female probands were analized in linear and angular measurements of the various regions of cranium, maxilla and mandible.
The faces of parents of cleft lip and palate children were more convex with a clock-wise rotation of chin point in spite of shorter vertical and horizontal measurements of maxilla. The mandibles of parents accompanied by large gonial angles and steep mandibular plane angles were analogous to those of individuals with cleft lip and palate. The thinning of upper lips of parents might be thought as the preposition to congenital cleft lip.
These findings were consistent for both fathers and m others of cleft lip and palate children, but more conspicuous morphological variations were found in fathers.

View full abstract

Most cases of general anesthesia for oral surgery in the Dental Hospital of Tokyo Medical and Dental University are pediatric cases for cheiloplasty and palatoplasty. We made a statistical survey of general anesthesia for cheiloplasty and palatoplasty during the 5 yeras from 1972 to 1976.
The children less than 6 years o ld who had undergone operations for cheiloplasty and palatoplasty were chosen as subjects. There was a total of 2925 cases of general anesthesia during these 5 years, of which 1338 (46%) were cases of cheiloplasty and palatoplasty; and of these 693 (52%) were cheiloplastics and 645 (49%) were palatoplasties. Among these cases, the majority used GOF anesthesia and the so-called Jackson-Rees technique, which is inhalation of nitrous oxide and oxygen followed by a muscle relaxand. Penthrane has not been used in our hospital since 1974 because of possible kidney damage.
Complications during and after cheiloplasty and palatoplasty operations were mostly respiratory. There were more after operations than during operations, and many appeared palatoplasty which requires lengthy surgery. The poorer the preoperative surgical risks had more postoperative complications. As to digestive complications, much vomiting was seen in palatoplasty due to deglution of blood. Judging from the amount of experience of the anesthetists, it is true that postoperative complications appeared in many cases when the anesthetist had little experience, but there were complications even when the anesthetist was experienced. Regarding blood loss volume, there was no significant difference among the various anesthetic methods, but there was a tendency toward less blood loss in GOF anesthesia, under which the circulatory system can be controlled easily.

View full abstract

Clinico-statistical investigation was made in 356 families with cleft lip and/or clft palate who had undergone a primay operation at the Department of Oral Surgery, Osaka Roosai Hospital.
The incidence of these diseases at the Department of Obstetrics in this hospital was 0.23%,1: 425.
As for the ages of mothers at birth, mothers aged under 30 were found in 81.7% of the total and those aged above 31, in 18.3%, of which 13 cases were delivered at the age of above 36.
As to the age difference of parents,2-year difference stood first followed by 1-year, next 3-year, and then 4-year differences, but no significant difference were found among them. The first and second children were dominant in the birth rank, and the number decreased from the third children onward.
Associated congenital anomalies were in 21.0% of the total, of which Pierre-Robin syndrome and Strabismus occured frequently. Such a high incidence as 36.4% was recorded as to complication in cleft palate.
Consanguineous marriages were found in 1.4% of the affected families, a lower value than in the normal population.
Familial occurrence was found in 38 of 356 families (10.7%), and there were 9 families of cousin-affection and 8 families of one parent-affection. As to cases with cleft lip, there was each one family of affected parents and siblings; one parent, sibling and uncle, and of affected cousin and uncle.
In normal parents cleft lip occurred in 0.6% of the siblings; cleft lip and palate, in 3.4%; and cleft palate, in 2.5%. Thus, the occurrence in siblings was found in 8 cases of the 376 siblings (2.1%).
There were 2 families of affected father and 7 families of affected mother. Out of such one parent-affected families, there was a family (mother, uncle and sister were affected) in which another occurrence was found (in a younger brother), such as not reported hitherto.
Noreport has been found on parents-affected families so far in Japan. A rare cases of such a family was stated in this report in which all of siblings were affected. Namely, father and siblings (a brother and two sisters) ans all bilateral cleft lip and alveolus, although the mother suffered from left incomplete cleft lip.
There were 6 pairs of twin, all of which were discordant.

View full abstract

During past 4 years of from April, 1974 to March, 1978,57 patients with cleft lip and/or palate were treated in the Department of Oral Surgery 11, Matsumoto Dental College. The ideal treatment for those patients should be established by the TEAM APPROACH under continuous cares through their lives.
This was a report of the statistical analysis and the p lanning of treatment for the cleft lip and palate patients in our clinic.

View full abstract

To make clear the factors which might be effective for speech therapy, for the patients who had obtained abnormal articulation skill without palatal repair, the articulation and the velopharyngeal movement before surgery and the achievement for blowing, gargling after surgery were studied.
Pharyngeal flap operation w as performed on 16 adult patients with cleft of the palate and 56 percent of them achieved to show normal articulation during speech therapy for 1 or 1.5 years.
Some of the results indicated the importance of these factors as follows:
1) normal speech could be obtained after surgery in patients withou t pharyngeal fricatives sound and/or glottal-stops before surgery.
2) near normal speech could be obtained after surgery in patients who showed almost similar velopharyngeal movements for each syllable before surgery.
3) those patients who could have good skill for blowing, gargling within 6 months after surgery revealed normal speech at the judgement after I or 1.5 years.
These results suggested that a. to induce the ability for controlling the intra-oral airflow without nasal emission, b. to get the ability as quickly as possible after surgery, might be thought to be much more important for obtaining normal speech after surgery, as well in adult patients as seen in young patients.

View full abstract

Phonetic research on hypernasality must be made from various viewpoints including resonance, vocal intensity and pitch (fundamental frequency). The authors have conducted various studies on each of these areas. In the present research, they investigated the pitch factor on the basis of 953 randomly selected cleft palate patients, ranging from 4 to 9 years of age, who visited our university clinic over the past 10 years. Fifty-six normal subjects, aged 4 to 6 years, served as the control.
A frequency analysis was conducted by sound spectrography on the phonation of the isolated vowel soun ds / a/ and / i/. When the fundamental frequency was measured, results showed no correlation between the degree of hypernasality and the pitch with either /a/ or /i/ vowels. However, a slight difference was found only with the vowel / i/ between the fundamental frequencie s of cleft palate patients and the control.

View full abstract

Cengential fistula of the lower lip is relatively rare congential malformation. It is well known that the fistula has close association with facial cleft.
The authors had exam ined 19 individuals having lip fistulas from January,1953 to February,1978.
Male to female ratio is a 11 to 8.
Fifteen case out of 19 (78.9 per cent) have association with cleft lip and palate.
The incidence of lip fistulas in a cleft lip and palate material was approximatel y0.3 per cent in our series.
A distinct familial occurance was established in the majority of the cases.
Elliptical excision of the fistula to the lip with removal of salivary g land gave a satisfactory result.

View full abstract

The changes of the palatopharyngeal sphincter's mechanism were observed in two cases who were resected the half part of soft palates because of the tumors. The voice sounds, the electromyograph of M. Levator Veli Palatini, the oral air pressure, the nasal air leakage, and the nasopharyngeal fiberscopic photograph were recorded and calculated till they attained the acceptable speech.
The results were as follows.
1. Typical defects in cle ft palate speeches were observed in both cases, including the pharyngeal fricative, after the resection of soft palates.
2. Electromyographic activities during swallowing and blowing showed the high amplitudes after the resection of the soft palates, but those during phonations had no change in the strength or pattern.
3. By the use of speech-aid, the acceptable speech were easily attained without the speech therapy.

View full abstract

[in Japanese]

View full abstract