The present study investigated occlusion of unilateral cleft lip and palate in children with mixed dentition and then determined the influences of occlusal assessment using the Goslon Yardstick on dentofacial skeletal patterns.
Methods: We separated 21 children with unilateral cleft lip and palate who had been treated consistently in our department into two groups based on favorable or poor occlusion after occlusal assessment using the Goslon Yardstick. The lateral cephalogram at an average of 8 years of age was applied and we obtained 11 angular and 11 linear measurements.
Results: ∠ SNA and ∠ ANB were significantly greater in the favorable occlusion group than in the poor occlusion group. The linear measurements Ar-A and S-N were significantly greater, whereas those of Ar-Go and N-Go were significantly smaller in the poor occlusion group than in the favorable occlusion group.
Conclusions: The present results suggest that favorable occlusion with a proper maxillomandibular relationship is one factor affecting the midfacial profile of children with cleft lip and palate.

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Chin caps and frontal pull appliances to the maxilla have been used for primary anterior crossbites, but previous studies of the treatment effect have highlighted problems, such as pressure on the temporomandibular joint (TMJ) and cranial bones. Therefore, to reduce these problems on the TMJ and cranial bones, a functional orthodontic appliance, Muh shield (YC3), was developed to improve the overjet and overbite in the primary dentition. However, there have been no reports on application of the Muh shield to cleft and lip palate patients although there are some reports on primary anterior crossbite orthodontic patients. Therefore, we applied the Muh shield in two young patients with cleft lip and palate. The aim of this study was to examine the treatment effects of the Muh shield in correcting cleft lip and palate in young patients.
Case 1 was a girl who was 5 years and 6 months old. The patient presented as follows: overjet 0 mm, overbite 0 mm, terminal plane: mesial step type, ANB + 4.0°. The patient was diagnosed as leftside cleft lip and palate. As a result of treatment, ANB of case 1 increased from 4.0° to 5.5°, and there was skeletal improvement. After using the Muh shield for 2 years and 6 months, only the lateral central incisor increased from overjet 0 mm to 2 mm.
Case 2 was also a girl who was 5 years and 7 months old. The patient presented as follows: overjet -1 mm, overbite +4 mm, terminal plane: mesial step type, ANB + 1.0°. The patient was diagnosed as isolated cleft plate. As a result of treatment, ANB of case 2 increased from 1.0° to 2.0°, and there was skeletal improvement. Both cases showed a clockwise rotation of the mandible and retrusion. Furthermore, case 1 indicated downward and forward growth and case 2 indicated only downward growth of maxillary.
These results indicate that the Muh shield improves functional effects on the skeletal system during primary dentition in cleft lip and plate patients. The Muh shield might be effective during primary dentition because it reduced the risks of caries and obstruction of teeth eruption. We will continue studies in the near future.

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In 50 patients with submucous cleft palate who had visited our department during the period from 1985 to 2003, the velopharyngeal function was examined according to their treatment courses.
1. The subjects enrolled in this study were composed of 24 males (48.0%) and 26 females (52.0%).
2. The subjects age ranged from 1 month postpartum to 29 years with the average of 5.08 years old.
3. Their main complain was verbal problems in 30 cases (60.0%), request of detailed oral examination in 15 cases (30.0%), request of surgical intervention in 3 cases (6.0%), and request of orthodontic/prosthetic treatment in 2 cases (4.0%).
4. According to the treatment course, there were 27 cases in the operated group (65.1%),14 cases in the non-operated group (34.1%) and the remaining 9 cases in other group (1.8%).
5. The velopharyngeal function evaluated after operation (averaged 18 months postoperatively) was good (good + fairly good) in 70.4% of patients in the operated group and 84.1% of patients with no mental retardation. In the 8 cases with mental retardation, the velopharyngeal function was evaluated as good (good + fairly good) in 37.5%.
6. The velopharyngeal function evaluated after observation period or verbal treatment in the nonoperated group was good (good + fairly good) in 92.8%.

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Object: We have performed gingivoperiosteoplasty (GPP) at the time of primary cheiloplasty for unilateral cleft lip and alveolus (UCLA). The purpose of this study was to investigate the relationship between bone formation after GPP for UCLA and cleft width.
Method: GPP at the time of cheiloplasty was performed in 18 cases with UCLA irrespective of cleft width at 2-6 months of age (average age: 3.5 months). Bone formation was evaluated at age 5 years using CT by an orthodontist.
Results: Bone formation was recognized in all cases postoperatively and there were no postoperative complications such as primary teeth damage, infection, and postoperative bleeding. Ten cases (55.6%) had sufficient bone formation and did not need subsequent SBG. The patients with narrow cleft (< 5 mm) showed a marked tendency to form enough bone as compared with the patients with wide cleft (> 6 mm).
Discussion: It is suggested that the patients with wide cleft (> 6 mm) may require presurgical orthopedic treatment. Even if SBG is needed after GPP, SBG could be performed easily. This is because the alveolar cleft has already been covered by the periosteum and some amount of bone has been formed in the cleft when SBG is performed. It is considered that the GPP technique is an effective procedure and could be widely used in Japan.

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Objectives: The purpose of this study was to investigate long-term developmental changes of nasal form in patients with complete unilateral cleft lip and palate (UCLP).
Subjects and Methods: The subjects comprised 11 boys and 10 girls with UCLP (CL group) born between 1982 and 1990 who had undergone two-stage palatal closure along with Hotz' plate. Control subjects were composed of 10 boys and 10 girls without UCLP (NCL group) who had undergone the first phase of orthodontic treatment for anterior crossbite when aged between 8 to 10 years. Lateral cephalograms taken between 8 and 14 years old were divided into four age groups of 8,10,12 and 14 years old. After lateral cephalograms were traced, they were superimposed on various structures of the frontal cranial base. The FH plane was selected as a reference line, and then angular and linear measurements were performed.
The results were as follows:
1. The horizontal position of the maxilla in the CL group was more posterior for both boys and girls than that in the NCL group, indicating the tendency toward maxillary deficiency.
2. In terms of nasal appearance in soft tissue profile, while the CL group had a backward positioned nose compared with the NCL group, there was no statistical significance in nasal height (Pn-Sn) between the CL and NCL groups in both boys and girls.
3. As for nasal form, dorsal angle of the nose (∠ 1) and curvature of the nasal base (∠ 4) were significantly small and large respectively, for both boys and girls in the CL group compared with the NCL group.
4. The horizontal and vertical positions of the nasal bone and the maxilla to the cranial base may be associated with nasal form.
5. Changes in the amount of the nasal apex every two years were less than one degree for both boys and girls, suggesting that the shape of the nasal apex is maintained in children of the ages observed.

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It is essential to analyze the face form of cleft lip patients by a three-dimensional approach for evaluating the jaw growth and choosing of the operation method.
Because a conventional face gypsum model and 3D images on a computer have little visual information due to a single color, being used, it is difficult to identify person or individual parts.
We integrated the face form of a cleft lip patient with color information on a computer using 3-dimensional computer graphic (3DCG) software and displayed it.
A preoperative face gypsum model of the patient was measured with a non-contact threedimensional laser measurement system, and the provided three-dimensional data and the face photograph of the patient were input to the 3DCG software. We built a three-dimensional face model which included color information by unifying both data.
The model made by rendering the image was sufficient to perceive substance and perspective. The model could be moved and turned on the computer, and search from every direction was possible, too.

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Treatment of a patient with bilateral cleft lip and palate with a wide alveolar cleft due to severe atrophy of the pre-maxilla is described. A 31-year-old woman presented with masticatory dysfunction and a foul smell coming from the nose. To treat alveolar cleft, we developed a procedure consisting of alveolar bone transportation, reduction of the alveolar cleft, and grafting of particulate cancellous bone. To compensate for poor maxillary growth, maxillary anterior movement with distraction osteogenesis was performed. Occlusal rehabilitation was achieved by setting a partial denture to the maxilla and placing dental implants into the mandible.
As a result, both facial appearance and masticatory function were satisfactorily improved.

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