Palatal lift prosthesis (PLP) is widely used for the treatment of velopharyngeal incompetence in cleft palate patients. In this study, we investigated the effects of PLP on velopharyngeal closure function (VPF) in 13 cleft palate patients with poor movement of the soft palate, by evaluating the velopharyngeal function after speech therapy with PLP. Speech therapy was started at the age of one year and 9 months on average. In slightly poor and poor VPF patients, PLP was set at the mean age of 6 years and 8 months, and 5 years and 11 months, and used for 13 months and 21 months on average, respectively. The velopharyngeal function improved in 11 of the 13 patients (85%). Furthermore,5 of the 13 patients (38%) obtained good VPF without PLP after speech therapy with PLP. Four of the five patients had shown slightly poor VPF before the speech therapy improved the velopharyngeal function to adequate velopharyngeal function without PLP. Thus, speech therapy with PLP is useful for improving the velopharyngeal function in a cleft palate patient with poor movement of the soft palate.

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[in Japanese]

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To evaluate the influence of maxillary platform deformity on cleft lip nasal deformity, graphic software was used to analyze the CT volume data following cheiloplasty (mainly Millard method and Randall method) and rhinoplasty (alar cartilage suspension through IC incision) of 22 children with cleft lip and palate.
Using CT volume data on the mid-face region of each patient before secondary lip repair or alveolar bone graft, the following were measured on computer images, and the results were analyzed for statistical relationships:
(1) The ratio of both sides of the thickness of the soft tissue on the alar base, (2) the horizontal width of the alveolar cleft of the hard tissue, (3) the sagittal depth of the alveolar cleft of the hard tissue, (4) the ratio of both sides of the horizontal distances from the facial midline to the most lateral portion of the alar groove, and (5) the ratio of both sides of the horizontal distances from the facial midline to the edge of the piriform aperture.
Quantitative analysis revealed that there were significant positive relationships between (1) and (3), (2) and (3), and (4) and (5) in the cleft lip group. There was also a significant positive relationship between (4) and (5) in the cleft lip and palate group. These findings suggest that restoration of symmetrical alveolar form and the piriform aperture adjacent to the cleft portion are highly desirable before correction of cleft lip nasal deformities is performed.

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A newly developed palatal plate with a nasal stent was used in presurgical orthodontic treatment for neonates with cleft palate to correct the cleft nose deformity. The effect of the device was analyzed quantitatively.
18 neonates were analyzed.10 patients were treated using palatal plates with a nasal stent, and 8 using palatal plates without a nasal stent.
The palatal plate was made of acrylic resin or thermoplastic material, and the nasal stent was added by implanting a Co-Cr wire (diameter 0.9 mm) in the plate. The resin bulb was attached to the other edge of the wire.
The bulb and stent portion were bent to extend the alar nasi of the cleft side antero-superiorly and medially. Plaster was applied to decrease the cleft lip gap.
Measurement using digital photographs taken before and after the orthodontic treatment was carried out to analyze the asymmetry of the external nose, the degree of the shifted columella, and the change of “ nasal tip / ala nasi” ratio.
The results showed significant improvement of the asymmetry of the external nose and the shifted columella in the patients using a nasal stent. Concerning the change of the nasal tip / ala nasi, no significant difference was observed between the two groups.
These results suggested that the palatal plate with a nasal stent is useful to correct the nasal deformity, and thus can play an important role in presurgical orthodontic treatment.

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It has been reported that the levator veli palatini muscle of speakers with velopharyngeal incompetence tends to demonstrate muscle fatigue during connected speech. This study examined whether a speech aid prosthesis might reduce the levator muscle fatigue of such speakers.
Eight patients with postsurgical cleft palates served as subjects. Four of the subjects wore a palatal lift prosthesis; the other four wore a bulb-attached palatal lift prosthesis as a speech aid prosthesis. Each subject was asked to pronounce the syllable [p_??_] more than 50 times at a rate of one time per second. Mean power frequency (MPF) of one syllable was obtained from electromyography data of the levator muscle by power spectral analysis. The MPF regression line against the course of syllable repetition was calculated. We interpreted this regression slope as a sign of the degree of fatigue of the levator muscle.
The absolute value of the slopes of the regression lines with speech aid prosthesis were significantly smaller than those without speech aid prosthesis. That is, it was shown that the speech aid prostheses reduced the decrease in MPF during speech.
These results suggested that speech aid prostheses reduce the levator muscle fatigue of postsurgical cleft palate patients with velopharyngeal incompetence during connected speech and the effect is not dependent on the type of speech aid prosthesis worn by the speaker.

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A clinicostatistical study was conducted of the cleft lip and/or palate patients who visited Kikuchi Orthodontic Clinic during a period of 30 years from its opening, and the following results were obtained.
1. The study included 159 males (57%) and 121 females (43%). The male- female ratio was 1.3: 1.
2. When classified by cleft type,207 patients had cleft lip and palate,32 patients had cleft lip alone, and 41 patients had cleft palate alone.
3. The average age at initial visit was 8y7m with a range of 2y5m to 29y9m.
4. By referral source,136 patients were referred from university hospitals, national and public medical institutions in Tochigi Prefecture,64 patients from university hospitals and private medical institutions outside the prefecture,45 patients from general practitioners' clinics in the prefecture,12 patients from public health centers in the prefecture, and 23 patients from others.
5. Angle's Class I, Class II and Class III malocclusions were seen in 11,6 and 18 patients with bilateral cleft lip and palate; 76,12 and 84 patients with unilateral cleft lip and palate; 25,2 and 5 patients with cleft lip; and 18,8 and 15 patients with cleft palate, respectively.
6. Crowding was the most common intraoral finding with a prevalence of 80%. Anterior crossbite was found in 76% of the subjects.
7. Both the maxillary right and left lateral incisors were congenitally missing in 31% of the patients with bilateral cleft lip and palate, while 37% of the patients with unilateral cleft lip and palate had a congenitally missing maxillary lateral incisor on the cleft side.
8. The number of surgical procedures performed after the start of orthodontic treatment totaled 252 from 1975 to 2004,92 of which were bone grafts. This was followed by 72 cases of lip repair,62 cases of external nose repair,21 cases of fistula closure and 5 cases of mandibular setback.
9. The average duration of active orthodontic treatment (initial visit to start of retention) was 8.5 years for the 187 patients who entered the retention phase.

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We carried out a statistical analysis on 174 patients with cleft lip and/or palate who visited our clinic from 1999 through 2003.
The results were as follows:
1) The total number of patients was 174.
2) The gender breakdown was 84 males (48.3%) and 90 females (51.7%).
3) Most of the patients visited for their first time at the age of 6 or 7.
4) 73 patients (42.0%) were from Saitama,59 (33.9%) were from Tokyo, and 18 (10.3%) were from Kanagawa.
5) Of the 174 patients referred to us from elsewhere,82 patients (47.1%) were from other university hospitals, while 75 (43.1%) were from other general hospitals.
6) The incidence of each type of cleft lip and/or palate was as follows: Cleft lip and palate (CLP): 94 cases (54.0%), cleft lip and alveolus (CLA): 33 cases (19.0%), cleft palate (CP).29 cases (16.7%), cleft lip (CL): 17 cases (9.8%), and median cleft lip: 1 case (0.6%). The laterality (the ratio of left to right side) was as follows: Unilateral CLP 4.0: 1, Unilateral CLA 2.9: 1, Unilateral CL 1.7: 1. More males had CLA, while more females exhibited CL and CP. There was no appreciable difference between genders for CLP.
7) Anteroposterior occlusal relationship was characterized by minus overjet in 69.5 % and plus overjet in 20.1%.

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As the cleft palate team of Shizuoka Children's Hospital, we encountered 205 patients with submucous cleft palate from 1977 to 2005. The results were as follows:
1) The incidence of submucous cleft palate among 1435 cleft lip and/or palate patients was 14.3%.
2) Cleft lip and/or palate were found in 22 families (10.7%).
3) Associated anomalies were found in 51.7%. Mental retardation, chromosomal aberration and malformation syndrome, cardiac anomaly, and cleft lip were found with a high frequency.
4) Sixty-eight patients with surgically untreated submucous cleft palate had adequate velopharyngeal function.
5) A significant relationship was found between associated congenital anomalies and velopharyngeal function.
6) Pharyngeal flap was a more reliable procedure than pushback palatoplasty.

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The main concern of preschool children with cleft lip is the cleft lip nose. We do not correct the external nose at the first surgery except for the formation of the nasal cavity floor and management of the soft tissue bulges because the undercutting of the nasal cartilages at that time impedes subsequent rhinoplasty.
The surgery is characterized by (1) open method by elephant nose incision, (2) atraumatic dissection of the bilateral alar cartilages, (3) advance and augumentation of the nasal column, followed by conchal cartilage graft for spring support, and (4) correction of the position of alar base and nasal cavity floor.
Cleft lip nasal deformities result from various factors including tissue deficiency of the cleft lip, alveolar or maxillary strain, and soft tissue contractures caused by abnormal muscular pull on the nasal structures. Since the deformity progresses over time, the correction of the lower third of the nose except the nasal septum should be performed as soon as possible after the patient reaches the age of three when it becomes easier to handle the cartilages. Completely separating the alar cartilages from the surrounding strain enables correction that can be achieved by one-stage repair with less relapse. The approach of incising the columella base is advantageous from an esthetic viewpoint, but has a drawback that the augumentation of the nose increases the tension at the suture line, producing the possibility of lip scar hypertrophy when cheiloplasty is performed at the same time.
We have effectively treated children with cleft lip nose by the early open method. This paper describes the procedure and favorable outcomes obtained from the six-year follow-up of the patient until early adolescence.

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We report a case with Robin sequence that complicates the cleft palate. A young female with cleft palate featured severe maxillary transverse contraction.
She received the first orthodontic examination at five years and ten months old, but was not treated at the early stage due to wearing of the deciduous teeth.
From ten years and seven months old, we expanded her maxilla by about 20 mm using suture splitting. Then reconstructive operation of the palate with buccal mucosal graft was performed to close the fistula and release the tension band of the palate. The multi bracket treatment was performed for two years and ten months. Although she is under observation after occlusal reconstruction even now, the convalescence seems agreeable.
In observing passage, the direction of mandible growth was downward. The maxilla and mandible growth were found to be forward after treatment.
The patient's language function has been improved by orthodontic treatment and operation such that there is no obstacle in daily life.

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