Velopharyngeal incompetency due to cleft lip and palate causes both feeding and speech disturbances. Furthermore, maxillary growth suppression may gradually occur if a plastic operation is invasive. The aim of palatoplasty is not only to close the cleft but also to avoid these secondary problems. Therefore, a long-term follow-up study is necessary to evaluate the outcomes of the multidisciplinary team approach including the timing and method of palatoplasty. We report here on the cephalometrical analysis of the two-stage palatoplasty/Hotz plate approach for 56 patients with unilateral cleft lip and palate (TS group) who are over 15 years of age to evaluate the extent of maxillary growth using lateral cephalograms. Fifteen cases who had undergone one-stage palatoplasty from 1974 to 1982 using the push back method (PB group), and the normal range of adults reported by Iizuka and Ishikawa were used as controls.
As a result, the maxillary growth in the TS group was found to be similar to that of ordinary people without cleft lip and palate compared with the PB group. Especially, points“ A” and“ Ptm'” were significantly different between these two groups.

View full abstract

Problems on the eruption of the upper second molars, such as ectopic and delayed eruption, and impaction, are frequently observed in cleft lip and palate (CLP) patients. On the other hand, distraction osteogenesis (DOG) has been employed for the treatment of severe maxillary growth retardation in CLP patients. A significant bone apposition to posterior maxillary tuberosity is expected in DOG. This study was conducted to investigate the upper second molar eruption in CLP treated by DOG. The eruption pattern of 14 upper second molars showing significant shortage of the eruption space was surveyed using orthopantomogram, lateral and anteroposterior cephalogram, computed tomogram, and dental cast taken at the following stages: less than 3 months before DOG and more than 12 months after DOG. As a result,8 teeth erupted,2 teeth penetrated alveolar bone, and 4 teeth migrated within alveolar bone. Individual cases demonstrated: 1) Ectopic eruption of the second molar due to the lack of space was predicted before surgery in an 11.9-year-old subject. However, normal eruption was observed following DOG.2) The second molar with mostly completed root in a 15.2-year-old subject erupted following DOG.3) The impacted second molar with completed root in a 21.0-year-old subject started to erupt into the normal position following DOG. We conclude that successful normal eruption of the upper second molar could be expected by the posterior bone apposition to the maxillary tuberosity following DOG even in cases with predicted ectopic eruption or impaction before surgery.

View full abstract

Abstract: Purpose: To perform content analysis of EPG studies in Japanese journals.
Data extraction and analysis: We extracted 39 articles from the database of “ Japan Centra Revuo Medicina: version 3”, using the key word “ palatograph”, and analyzed the journal of publication and year, authors' speciality, the aim of using EPG, subjects' information, types of EPG system, and other test methods used with EPG.
Results and conclusion: Nearly half of the articles were published in dental journals and the number of articles was the most in the 1980's and gradually decreased. Half of the authors were dentists, followed by speech-language-hearing therapists, however, only one fifth of the studies utilized EPG as a therapeutic tool. The largest population of subjects was a normal case and the second largest group was a patient with organic disorders, such as cleft palate or oral cancer. Dynamic Palatograph (Rion Company) was used in most of the studies, and a variety of test methods, such as perceptual assessment of speech, sound spectrography, cine-radiography, and ultrasound tomography, were used along with EPG.
Based on these research results, it is desirable to promote the clinical application of EPG as an objective and scientific tool in speech, language, and hearing therapy.

View full abstract

Mongolia is one of the Central Asian countries where almost no studies exist concerning the prevalence at birth of orofacial clefting. Therefore, the purpose of this retrospective study was to estimate the prevalence at birth of cleft lip and/or palate (CUP) in Mongolians based on the limited available data. This is the first assessment of its kind conducted at the international level in Mongolia regarding the prevalence at birth of CL/P.
Case reports of CL/P in newborns for the period from 1997 to 2001 were included in the study. Birth prevalence was determined by a 5-year hospital-based study from data kept at the Maternal and Child Health Research Center (MCHRC) Hospital, Ulaanbaatar, which comprised 24,970 consecutive live births.
CL/P were found in 19 of 24,970 newborns, for a total birth prevalence of 0.76 per 1000, or 1/1314. The birth prevalence of CL/P in Mongolians was estimated to be low. This report is preliminary and does not contribute to knowledge on the cause, prevention, and treatment of CL/P, but rather provides descriptive information on the basic epidemiological situation in this nation. The specificity of the socioeconomic conditions in Mongolia differs from those of other countries where CL/P have been extensively studied, making it worth evaluating the CL/P situation in this population. This study outlines the necessity of future prospective investigations, including data from other delivery hospitals, to confirm the current figures substantiating the hypothesis for the low prevalence of CL/P in Mongolia.

View full abstract

Primary objective: To determine the effectiveness of electropalatography (EPG) home training using a portable training unit (PTU) for a patient with residual articulation disorders.
Methods and procedures: The subject was a post-surgical bilateral cleft palate patient whose velopharyngeal function was adequate. She started EPG home training at the age of 8 years 4 months, because she had residual articulation disorders such as palatalized or lateral misarticulation, although she had received conventional speech therapy for more than 4 years.
The WinEPG system (Articulate Instruments, Edinburgh) was used to make recordings during the initial assessment and the monthly follow-up.
Experimental interventions: A training program was developed at each session, and she was instructed to carry out her homework assignments using the PTU.
Main outcome: After 13 months of home training, marked changes in the EPG patterns and‘ Center of Gravity: COG’ values were observed.
Conclusions: Compared to conventional therapy, EPG home training resulted in a much quicker improvement in target sound production.

View full abstract

We conducted a survey of actual conditions to establish a system on the part of the medical treatment provider so that pregnant women diagnosed as having fetuses with a cleft lip and/or palate can deliver at ease.
The survey was conducted on 12 mothers who had been so diagnosed before birth and 6 obstetricians who notified the mothers of the diagnoses. Each pregnant woman received a semiconstitutive interview of 30 minutes to one hour and was subjected to analysis by the KJ method, to identify whether or not she had a medical support system by the medical treatment side and what kind of medical support she needed.
Four mothers and 1 obstetrician replied“ Yes” that support was available, while 8 mothers and 5 obstetricians responded“ No. ” Types of medical support that the mothers wanted to receive were: (i) Explanation of medical aspects, (ii) Explanation of medical treatment/nursing and infant upbringing, and (iii) Continual support.
In order to fulfill these three desires, it is necessary to provide pregnant women with cleft lip and/ or palate information before birth. We suggest a support system centering on medical doctors and the nursing staff.

View full abstract

We conducted maxillary distraction by utilizing the rigid external distraction system (RED system) in two patients with severe maxillary dysplasia in bilateral cleft lip, alveolus and palate. For these two cases, we examined: 1) maxillary bone displacement and 2) tooth movement against maxillary bone, using maxillary bone implant markers.
In both cases, patients received alveolar bone grafting. Case 1 was a girl who was 11 years and six months old at the time of maxillary distraction operation, and case 2 was a girl sho was a 16 years and eight months old. Case 2 received mandibular retraction with sagittal splitting ramus osteotomy 22 days after the distraction osteogenesis. We conducted the distraction osteogenesis on a high transverse (Le Fort I) maxillary osteotomy after having fixed an attraction hook. Distraction was continued at the rate of 1 mm/day until the desired amount of maxillary movement (case 1 was 9.0 mm, case 2 was 8.0 mm as the length set for distraction) was achieved. With both patients' approval, we placed four implant pins into both the upper and lower osteotomy line in order to estimate tooth movement against maxillary bone precisely. Cephalometric radiograph tracings were obtained corresponding to the pre-operation, post-operation and 2-year postoperative period. Based on these observations, we studied 1) the displacement of an implant marker below the osteotomy line which was indicated by an implant marker above the osteotomy line and cranial base, and 2) the displacement of the maxillary incisor which was indicated by an implant marker under the osteotomy line and palatal plane. The distraction length at the screw head was 15.0 mm for case 1, and 34.0 mm for case 2, by the time we achieved the desired distraction length. The total displacement lengths for the implant marker were 11.2 mm anterior and 1.3 mm downward for case 1, and 7.5 mm anterior and 2.6 mm downward for case 2. As for the postoperative displacement length,1.8 mm (16.0%) against total distraction length of 11.2 mm was finally observed for case 1. However, for case 2, about 1.0 mm frontal displacement was found after the distraction. For both cases, vertical displacement was more obvious than horizontal displacement during the distraction. We were able to find the precise distance on cephalograms as to both the movement of maxillary bone and that of teeth because of these maxillary bone implant markers.

View full abstract

In this paper, we present the results of presurgical orthopedic treatment for patients with cleft lip and alveolus in Kanagawa Children's Medical Center. Five infants with unilateral cleft lip and alveolus were included in this study.
In these patients, we used an acrylic plate mimicking the normal alveolar form with adhesive paste or slim adhesive tapes fixed from, the hook to the cheeks.
The average age at insertion of the plate was 22 days of age, and average age at removal of the plate was 102 days of age. The average term of presurgical orthopedic treatment was 80 days.
The cleft width was reduced significantly, and the position of the margin on both segments improved vertically. Mesiorotation of the major segment and laterorotation of the minor segment were recorded.
In a patient without presurgical orthopedic treatment, the deformity of the major segment and the cleft width in the alveolus were not decreased.
In our procedure, morphology of alveolus altered to the normal form, thus facilitating primary gingivoperiosteoplasty at the time of lip repair.

View full abstract

We report a case of bilateral cleft lip and palate in a patient with a wide alveolar cleft due to severe atrophy of the pre-maxilla. The patient was a 33-year-old woman who presented with masticatory dysfunction and a foul smell in the nose. We performed oral rehabilitation by the following procedures: first, maxillary plasty was performed by means of an iliac bone graft; next, occlusal rehabilitation was achieved through the placement of dental implants following vestibular extension with a mucosal graft. As a result, her nasolabial form and masticatory function were satisfactorily improved.

View full abstract

In patients with cleft lip and palate accompanied by markedly poor maxillary growth, maxillary anterior movements are restricted by scar tissue formed in the palate. In such patients, distraction osteogenesis has been increasingly used as an effective method replacing conventional osteotomy. We performed simultaneous maxillomandibular distraction osteogenesis for bilateral cleft lip and palate accompanied by maxillomandibular poor growth, and obtained good results.
In the maxilla, Le Fort 1 osteotomy was performed, and a RED system for distraction osteogenesis was applied. In the mandible, mandibular body osteotomy was performed on the left side and mandibular sagittal split ramus osteotomy was performed on the right side, and an intra-wound mandibular distractor was applied only to the left side. From 3 days after operation, maxillary advancement was performed at a rate of 1-2 mm/day, and the maxilla was advanced by about 15 mm. After intermaxillary fixation, the left proximal bone fragment of the mandible was posteriorly advanced at a rate of 1 mm/day, resulting in about 10-mm advancement.
As a result, the depressed impression of the midface improved, and an almost appropriate maxillomandibular overlap relationship was acquired. In addition, the influences of maxillary anterior movement on nasopharyngeal closure were slight.

View full abstract

Although it is a congenital disease that brings about bilateral facial nerve paralysis, the Möbius syndrome may sometimes be accompanied by various symptoms depending on the parts and the degree of affection. We treated a 39-year-old female with velopharyngeal incompetence accompanying MObius syndrome, by lateral pharyngoplasty. Seven months after the surgery, soft palate elevation by fiber has been confirmed and speech has become clearer than before surgery.
This method is pharyngoplasty by using the salpingopharyngeaus muscle, and is expected to yield two improvements: 1) improvement in anatomical structures and 2) improvement in physical functions. Normally, the latter result often cannot be expected when the salpingopharyngeal muscle is completely paralyzed. In this case, however, muscular contraction of the mucomuscular flap that formed a sling was observed. It is inferred that it could have been because some function of the muscle, even though feeble, still remained. We conclude that this is a useful method that may achieve a functional improvement in patients whose salpingopharyngeal muscle does not seem to have totally lost its functions.

View full abstract