The objectives of this study were to observe the disappearance process of medial edge epithelium (MEE) in secondary palatogenesis of mice, and in vivo reproducibility. The organ culture method used by Shiota et al. is a rotary culture system in suspended liquid serum-free medium. This method simulates the process of secondary palate fusion in vivo/in vitro, and is widely used in the toxicological field. We observed the secondary palatogenetic process in ICR mice, and obtained the following results.1) A series of palate development processes from the contact of the palatal plates to the completion of palatal fusion were observed.2) Apoptosis contributed to the disappearance of MEE.3) The involvement of Fas/Fas ligand-mediated apoptosis was suggested.4) Nasal and oral epithelial triangles, which suggest migration, were observed.5) Cell mass excretion to lumen, considered to be the mechanism of cell rejection, was observed.
The results indicated that this or gan culture system morphologically reproduces the developmental process of secondary palate in ICR mice. It was considered that the influence of various factors on palate formation can be analyzed at each stage of secondary palate formation.

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[in Japanese]

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The suckling motion of infants with cleft lip and palate was investigated.
The subjects consisted of 6 patients with unilateral cleft lip and palate (UCLP group)wearing a Hotz palatal plate,8 with unilateral cleft lip (and alveolus) (UCL group),6 with cleft of the soft palate (CP group) and 10 normal babies (normal group).
Two pairs of surface electrodes were attached on the cleft side and non cleft side of the upper lip. Preoperatively (or at the age of 4 months) and 3 months following lip repair (or at the age of 7 months), oppressive pressure and negative pressure as well as electromyography were measured simultaneously during feeding using a nursing bottle equipped with two pressure transducers.
The resu lts were as follows
1. In the babies of t he normal group, electromyographical activity was observed on both sides equally corresponding to oppressive pressure (70 mmHg at 4 months and 75 mmHg at 7months) and negative sucking pressure ( 60 mmHg at 4 months and 62 mmHg at 7 months)alternating rhythmically during suckling.
2. In the CP group, values of peak EMG and total EMG resembled those of the normal group at 4 months and 7 months. Oppressive pressure was lower than normal. No negative sucking pressure was detected.
3. In the UCL group, preoperative peak EMG and total EMG on both sides were lower than those in the normal group and values on the cleft side were significantly lower than those on the non cleft side. Following surgery, those on both sides approximated those of the normal group. Oppressive pressure was significantly lower than that in the normal group both before and after lip repair. Negative sucking pressure, which was significantly lower than that in the normal group preoperatively, approximated the values in the normal group postoperatively.
4. In the UCLP group wearing a Hotz plate, preoperative peak EMG and total EMG were lower than those of the normal group and values on the cleft side were significantly lower than those on the non cleft side. Following, surgery, values on both sides increased but remained lower than the values in the normal group. Oppressive pressure was lower than that in the normal group before and after lip repair. No sucking pressure was detected either preoperatively or postoperatively.
5. The cycle d uration and rhythm of oppressive action did not show any significant difference among the four groups.

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A favorable outcome is now possible by the team approach to the management of patients with cleft lip and palate. However, practical problems remain regarding cooperation and networking among members of the team.
Nagano prefecture lies in a rural area of Japan, and patients must spend a great deal of time in visiting the outpatient department of a single central hospital. Therefore, a team approach in Nagano has been developed utilizing multi-center networking. Some divisions of the team, such as speech therapy, orthodontic treatment, and ear-nose-and-throat treatment, which require frequent outpatient visits, were decentralized and patients could receive treatment at local hospitals.
To maintain good communication among members of the team, the patients always brought a pocketbook in which members of the team wrote information about treatments received. Other team members could refer to this information when treating the patient on an outpatient basis. Local workshops were held yearly for members to increase their knowledge and to communicate with one another. A homepage of the team approach used in the Nagano model was set up to ensure freedom of information for the patients.

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We report a case with left cleft lip and palate accompanied by congenital missing of the lateral incisor, in which occlusal reconstruction was accomplished with a dental implant and orthodontic treatment.
Case: A young male wit h 1-CLP who had congenital absence of /2.
He underment an operation on his lip by the modified Davies' meth od at 3 months after birth, and his palate by the Manchester's method at 9 months. He had his first orthodontic examination at the age of 18. According to the treatment plan for him, illiac bone grafting to the alveolar cleft site was carried out after alignment of the teeth at the age of 23, followed by plantation of the dental implant. The occlusion of his permanent teeth was found to have stabilized except for a slight relapse at the outset of the retention stage.

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The purpose of the present study was to evaluate the changes in maxillofacial structure treated with Effective Maxillary Orthopedic Protraction (EMOP) in two patients with repaired unilateral cleft lip and palate (UCLP) with maxillary retrusion. The EMOP consisted of maxillary protraction and Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC) of the maxillary dental arch. Case 1: The patient was a 7-year-5-month-old girl, with left-side UCLP. EMOP was applied for 11 months. Case 2: The patient was a 5-year-5-month old boy, with left-side UCLP. EMOP was applied for 2 years and 3 months. The changes of maxillofacial structure treated with EMOP showed that point A was moved forward 2.73 mm/year in Case 1 and 2.67 mm/year in Case 2, and the SNA increased by 1.64° /year in Case 1 and 1.33° /year in Case 2. The results suggest the substantial effectiveness of EMOP in case of UCLP with maxillary retrusion.

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