The failure of rapid maxillary expansion when attempted in patients who had completed the ir adolescent growth spurt can be attributed to the rigidity of facial skeleton and to the sealing of zygomaticomaxillary palate and midpalate sutures. Especially, rapid maxillary expansion is difficult in adult cleft lip and palate patients. That is probably due to the specific type of suture closure in cleft lip and palate patients.
The authors carried out rapid maxillary expansion with Le Fort I osteotomy in four adult cleft lip and palate patients who suffered from maxillary retrusion and maxillary collapse. The good results were obtained.
The main features in this method are as follows:
1. Le Fort I osteotomy can be carried out even on outpatients under local anesthesia.
2. Maxillary expansion is accomplished in a short period after Le Fort I o steotomy without pain or pressure sensation.
3. Relapse a fter surgical and orthodontic correction of the maxillary arch is rather slight.
4. The expansions of the coronal arch width and the basal arch width are obvious. The nasal cavity width and the zygomatic width are increased in some patients. The inclination of maxillary a n teiror teeth is improved.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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One of the major objects of cleft Iip repair is to make the vertical height on each side of the Tip the same. Obviously, there are many variations in distances to which the Cupid's bow has to be dropped.
The aim of this paper is to present new equipments which facilitate a design for Cronin-ty pe lip repair. With the use of a special sliding caliper, the size of the flap can be determined easily by measuring the vertical heights of both the normal and the cleft side from the base of the columella to the superior peak of the Cupid ' s bow.

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A rare xeperience on primary operation for a 56 year old woman with irlcomplete cleft lip was reported.
The repair was done by Millard's method. Analysis of cephalometric roentogenogram before operation shows no depression of maxillary growth, meanwhile after operation shows a few downwards movement of point A, ANS, OR.

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Palatoplasty is usually performed when the patient is an infant. moreover, many patients have chronic infection of the upper airway. It is often seen that some patients have serious respiratory complications after the operations, because the field of the operation coincides with the upper airway. We here report two cases of respiratory complications obliged for us to maintain respiratory control for several days.
The first case is a lyr 9mon baby boy who fell into postoperative subglottic edema. Cough and rhinorrhea were observed a few days before the operation but the condition was not considered very serious, and the operation was performed. No trouble was seen during the operation, but approximately an hour and a half after returning to the ward, stridor and paradoxical respiration were observed and then he showed cyanosis. Re-intubation was performed immediately and he was placed in a humidified oxygen tent and administered medicine for 5 days. He gradually recovered and left the hospital 13 days after the operation.
The second case is a lyr7mon baby girl who fell into postoperative atelectasis. Her temperature rose to 38.9°C 4 days before the operation and was still 38.5°C on the next day, so she was given a febrifuge and temperature returned to normal, but cough and rhinorrhea were still observed. It was considered that the operation ought to be postponed but the surgeon insisted and the operation was performed. No trouble happened during the operation but after extubation, stridor and paradoxical respration were observed. Re-intubation was performed dimmediately and bronchial toilet and suction of secretions were repeated through the endotrachal tube. Approximately an hour later improvement was seen and the tube was taken out. But the next day she showed cyanosis and the endotracheal tube was inserted again and kept in for 4 days. After active respiratory care, she finally was able to leave the hosital 18 dasys after the operation.
Both of these cases fell into postoperative respiratory complications because of our ignorance of their poor physical status before the operation. No matter how much the surgeon insisted, we ought to have put off their operations.

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Two cases of rare type cleft palate are presented. They sh ow the opening of the hard palate and bifid uvula. The origin of this cleft palate is important to clarify the mechanism of cleft-palate formation. Our cases of epithelial fusion of the soft palate appear to suggest the post fusion rapture of the hard palate.

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