In patients with cleft lip and palate, the alveolar bone graft creates a continuous maxillary arch, closes the oronasal fistula, provides bony support for facial soft tissue and teeth, and facilitates orthodontic movement of teeth. However, pain at the donor site represents a significant source of postoperative morbidity. This study was conducted to evaluate postoperative pain and the ability to perform activities of daily living. Reconstruction of residual alveolar bone defects in 97 patients operated on between 1994-2002 were evaluated clinically.53were males and 44 females.24 had unilateral cleft lip alveolus,2 had bilateral cleft lip alveolus,46 had unilateral cleft lip and palate and 25 bilateral cleft lip and palate. The donor site of bone grafts in all cases was particulate cancellous marrow from the anterior iliac crest. A questionnaire was returned by 76 patients who were during the 6 months postoperative period. Responses regarding postoperative pain, time period to ambulation, and ability to perform activities of daily living were evaluated. We describe a technique for harvesting cancellous bone from the ilium that is minimally invasive and with which safe and sufficient bone graft material can be obtained. Cancellous iliac bone grafts are an important consideration when selecting donor sites for secondary bone grafting.

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We evaluated the alveolar cleft form and vertical bone bridge formation before and after secondary bone grafting, respectively by using dental X-ray computed tomography (D-CT). D-CT showed the synchronized sagittal, coronal, and axial views clearly, and provided critical threedimensional images of the alveolar clefts before bone grafting. Furthermore, D-CT revealed the critical labial-palatal bone width at voluntary dimensions based on the root length of the cleftadjacent medial tooth. In some cases, the score of vertical bone bridge formation evaluated by dental X-ray film was different from that by D-CT.
Thus, D-CT is a valuable tool to ass ess the three-dimensional forms of alveolar clefts and critical bone bridge formation in cleft patients.

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Nineteen patients having chromosome 22q11.2 deletion were compared with 29 nonsyndromic patients concerning their development, preoperative articulation, and postoperative results of pharyngeal flap surgery. The results were as follows:
1. All of the 22q11.2 deletion patients showed a n IQ lower than 75.
2. There was no significant difference in preoperative articulation between the two groups.
3. In terms of disappearance in nasal air flow at blowing based on the mirror test, there was no significant difference between the two groups.
4. In terms of disappearance in nasal air flo w at /a/ phonation based on the mirror test, there was a significant difference between the two groups. It took longer in the 22q11.2 deletion patients than in the non-syndromic patients.
5. Regarding the postoperative speech results,47% of the 22q11.2 deletion patients showed improvement. On the other hand,92% of the non-syndromic patients showed normal speech, so there was a significant difference between the two groups. Moreover,62% of the non-syndromic patients improved naturally without speech therapy, whereas only 18% of the 22q11.2 deletion patients improved naturally.
These results showed that pharyngeal flap operation was equally effective in both groups for improvement of VP function. Chromosome 22q11.2 deletion patients, however, might have some limitation in the postoperative improvement of speech.

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A clinical and statistical survey was carried out on patients with cleft lip and/or palate in the First Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-gakuin University, during the 20 years from April 1983 through March 2003. The results were as follows.
1. The number of new patients was 298 males and 273 females (total 517 patients).
2.354 patients (72.8%) were referred by obstetrics and gynecology (36.8% ) and pediatrics (36.0%).
3. Patients resident in Aichi prefecture accounted for the greatest proportion (375 patients: 65.6%), followed by 88 patients (15.4%) resident in Gifu prefecture, and 63 (11.1%) in Mie prefecture.
4. A classification according to case was as follows: cleft lip and palate (CLP) i n 240 cases (42.0%), cleft palate (CP) in 116 cases (20.3%), cleft lip (CL) in 102 cases (17.9%), and submucous cleft palate in 66 cases (11.6%).
5. There were many CLP and CL in males and many CP in females.
6. The laterality in cleft lip in 339 cases was unilateral in 242 cases (70.8%) and bilateral in 97cases (28.4%). The laterality of these cases was the left side in 139 cases (57.4%), and the right side in 103 cases (42.6%), with a left to right side ratio of 1.3: 1.
7. Other congenital anomalies and/or disorders were fo und to be associated in 73 cases (12.8%).

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A statistical study was carried out on 125 patients with cleft lip and/or palate who were treated in the Department of Orthodontics, Osaka Dental University during the 10 years from April,1992 to March,2002. The following results were obtained:
1. Cleft lip and/or palate patients accounted for 3.8% (125 cases) of all orthodontic patients (3,254cases).
2.95 (76.0%) out of 125 cleft lip and/or palate patients lived in Osaka prefecture.
3. The patients consisted of 58 males and 67 females.
4. The age of patients at first visit ranged from 2 to 37 years old and 73.2% of them were between 4 and 15 years old.
5. The inciden ce of the type of cleft lip and/or palate was as follows: Unilateral cleft lip and palate: 76 cases (60.8%), bilateral cleft lip and palate: 17 cases (13.6%), unilateral cleft lip: 14 cases (11.2%), cleft palate: 18 cases (14.4%).

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A statistical and sequential study was performed in 329 patients with cleft lip and palate in the Department of Orthodontics, Aichi-Gakuin University Dental Hospital, in the past 20 years from 1983 to 2002. Observation of the generation divided a document for 20 years into five groups (Group 1: 1983-1987, Group 2: 1988-1992, Group 3: 1993-1997, Group 4: 1998-2002), and each group was compared. The results were as follows:
1. The number of pa tients with cleft lip and palate was 329, accounting for 6.7% of all orthodontic patients. The patients were 172 males and 157 females with a male to female ratio of 1:0.9.
2. Cleft morphology was classified as follows: Unilateral cleft lip and palate was observe d in 41.0%, bilateral cleft lip and palate in 16.4%.
3. The peak age in the initia l diagnosis was 8 years (20.4%). The patients between 6 and 9 years old occupied 55.6%.
4. The ave rage value of ANB angle was higher in unilateral cleft lip and palate and cleft palate.
5. The patients with crossbite were 88.4%. The patients with crossbite involving the ante rior and bilateral buccal segment was 67.3% in Group 1, however the proportion in Group 4 decreased.
6. The patients who had congenitally missing teeth accounted for 68.2% of the patients with cleft lip and palate. Congenitally missing teeth of the maxillary lateral incisor on the left side were found in 29.6% of the patients and on the right side in 23.1%. The side on which there were congenitally missing teeth watched the cleft side.
7. The preferred orthodontic appliance was the Porter arch type of expansion appliance, accounting for 40.8% in Group 1, and 50.0% in Group 4. As the external anchorage appliance for improving skeletal problems, the chincap was used mainly in Group 1, and the maxillary protracter in Group 4.

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A case of bradycardia conceivably caused by vagovagal reflex after pharyngeal flap operation is reported. The patient was a 5-year-old girl. She was diagnosed as submucus cleft palate and was referred to our department for evaluation of speech. Her preoperative general condition was good. A pharyngeal flap operation was performed under general anaesthesia. Pre-medication was not given, and oxygen-sevoflurane was used for general anaesthesia. During the operation, the cardiovascular circulation was stable, and an electrocardiogram did not show any abnormality. On the third postoperative day, bradycardia was found. Her general condition was stable and no other abnormal signs were found. The bradycardia improved after removal of an oral splint covering the palatal wound on the seventh postoperative day. In this case, it was suspected that pneumogastric nerve reflex reaction and bradycardia were caused by mechanical stimulation of the oral splint and postoperative edema.

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In December 2004, an international meeting on the international collaborative research on craniofacial anomalies (CFA) named “WHO Meeting on International Collaboration to Reduce the Health-care Burden of Craniofacial Anomalies” was held at the headquarters of the World Health Organization in Geneva, Switzerland.
The meeting was held for three days and reports and discussions were made on the following themes: update on science and progress of international collaboration, presentation of models for interdisciplinary research on CFA, opportunities and obstacles to collaborative clinical research in each country and the WHO region, international database and registry on CFA, dissemination of good practice on genetic research, and interface between research and funding.In this meeting, a report on the present situation of collaborative clinical research in Japan was requested and the following contents were reported.1) Collaborative clinical research in Japan has just started.2) Two projects have been carried out in Japan. One was a nationwide survey of the occurrence and primary surgery of cleft lip and palate patients made by the Investigation Committee of the Japanese Cleft Palate Association (JCPA). The other was a six-center comparative study of treatment outcomes in patients with unilateral cleft lip and palate led by Niigata University with the approval of the JCPA.3) The collaborative research should be performed under the leadership of JCPA.4) It will take a considerable time for clinicians to understand the aims and benefits of collaborative research.5) The official recommendation of the World Health Organization for the evaluation of treatment outcomes may facilitate collaborative clinical research.

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