The purpose of this study was to investigate three-dimensional changes in the maxillary alveolar process and palate due to pre-surgical orthopedic treatment for ten infants with unilateral cleft lip and palate.
The palatal plate was made according to Hirakawa et al. The average age at start of the treatment was 26.2±17.0 postnatal days. The plates were worn just before cheiloplasty. The average treatment duration was 63.1±10.0 days. Pre- and post treatment dental models were measured three-dimensionally. The changes in the maxillary alveolar process and palate were analyzed by measuring linear and angular variables on three-dimensional images and the cross sectional images.
The cleft width was reduced significantly resulting from both mesial growth of the major segment and forward growth of the minor segment. The cross sectional images showed distance of mesial outlines of the major and minor segments decreased after the treatment.
The results suggested that pre-surgical orthopedic treatment with the palatal plate induces growth of both segments to the cleft and bone addition to alveolar and palatal surface, which may contribute to narrowing the alveolar and palatal clefts.

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Objective: The RYK, EPHB2, and EPHB3 genes are attractive candidates contributing to CL/P and CPO pathogenesis. That is because both RYK deficient mice and Ephb2/Ephb3 (genes for interaction molecules with RYK) double-mutant mice show cleft palate.
Setting: Mutation search on RYK, EPHB2 and EPHB3 was carried out in a large number of Japanese and Vietnamese patients with CL/P and CPO. We also performed a case-control study and transmission disequilibrium test (TDT) using three single nucleotide polymorphisms (SNPs) within a linkage disequilibrium block in RYK, and seven haplotypes that were constructed from the SNPs.
Results: A missense mutation, 1355G > A (Y452C), in RYK was identified in one Vietnamese patient with CL/P. This mutation was never found among 1,646 Vietnamese/Japanese/Caucasians including 354 CL/P and CPO patients. A colony formation assay using NIH3T3 cells transfected with mutant cDNA revealed that mutant RYK had a significantly reduced protein activity compared to those with the wild-type RYK, implying that the transformation ability of RYK is depleted by this mutation. Although the case-control study and TDT on three individual SNPs did not reveal any evidence for association with oral clefts, the case-control study on one rare haplotype suggested positive association in Japanese patients with CL/P and CPO. No mutations in EPHB2 and EPHB3 were found in any of the patients examined.
Conclusion: All of these findings suggested that a missense mutation, 1355G > A, and one rare SNP-haplotype may play a role in the development of CL/P in Vietnamese, and CL/P and CPO in the Japanese, respectively.

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Secondary bone grafting may play an important role in the treatment of patients with cleft lip and palate (CLP). At our department, we consider the esthetics and function, and attempt to improve the collapse around the ala base of the nose by alveolar bone grafting in all cases of CLP, and additionally perform simultaneous external rhinoplasty in some CLP cases. Although a three-dimensional evaluation method is needed to assess patients after secondary bone grafting, there are few simple evaluation methods available in clinics. We examined the differences between the preoperative and postoperative (six months) external nose form using a two-way face photograph (frontal and basal views). This study evaluated 22 subjects consisting of 10 patients with unilateral cleft lip and alveolar (UCLA) and 12 patients with unilateral cleft lip and palate (UCLP) who underwent secondary alveolar bone grafting at our department between January 2006 and December 2008.
Our results were as follows:
1. There was no significant difference between the surgical methods to shift the alar base in the two cleft types.
2. Ptosis of the superior rim of the nostril on the cleft side was noted before alveolar cleft bone grafting, but this was improved postoperatively. However, the difference was not significant.
3. There was no significant shift of the nasal tip between preoperative and postoperative findings after alveolar bone grafting and external rhinoplasty.
4. Shift of the columella might be improved after our procedure. In particular, there was a significant difference in patients with UCLA.
5. There was no significant difference between the affected and non-affected sides on the collapse around the floor of nasal cavity.
It was suggested that alveolar bone grafting combined with simultaneous external rhinoplasty effectively improved the esthetics as well as the function in our series.

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For this study, we developed a new diagnostic jelly to assess the chewing and swallowing functions of patients with a cleft lip and/or palate. Furthermore, by applying it to preschool patients and preschool children without craniofacial anomalies, we elucidated changes with age of the chewing and swallowing function and the difference between the patients and the control groups.
The subjects were 167 preschool (2-6-year-old) patients(preschool patient group)with a cleft lip and/or palate, who experienced occlusion management at Clinics for Maxillo-Oral Disorders, Tohoku University Hospital Dental Center, and 45 preschool(2-6-year-old)children (control group) attending nurseries or kindergartens in Miyagi and Shizuoka prefectures. Three new types of jellies with different hardnesses were made from gelatin, granulated sugar, and lemon essence for chewing and swallowing function assessment. Using the jellies, we measured the time spent from the start of chewing to the finish of swallowing and counted the number of chewing strokes. We divided each group into two sub-groups of 2-3-year old children and 4-6-year old children and compared the results of the respective groups, obtaining the following results.
1. For both the preschool patient group and the control group, the time spent from feeding to swallowing and the number of chewing strokes were significantly greater when using harder diagnostic jelly.
2. For the preschool patient group, as the children become older, the time spent from feeding to swallowing was significantly shorter when using hard diagnostic jelly, and the number of chewing strokes was significantly greater when using soft diagnostic jelly.
3. There were no significant differences between the preschool patient group and the control group in the time spent from feeding to swallowing and the number of chewing strokes.
The results obtained from this research suggest that as children become older, the chewing and swallowing functions can be expected to improve and that the chewing and swallowing modalities change depending on food hardness. Moreover, the results suggest that a cleft lip and/or palate might not necessarily cause functional problems under suitable occlusion management.

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In 80 children aged between 5 and 8 years with cleft lip and palate examined in our department in the three years from 2004 to 2006, dental caries in deciduous teeth were examined and the following results were obtained.
The incidence of dental caries in children by type of deformity was 100% for cleft palate, 88.4% for cleft lip and palate and 77.8% for cleft lip and alveolus. The average number of dft per persons and the rates of dft were 7.1 teeth (49.4%) for cleft palate, 5.7 teeth (40.6%) for cleft lip and palate and 4.3 teeth (30.5%) for cleft lip and alveolus. Dental caries showed the highest incidence for cleft palate, followed by cleft lip and palate, and cleft lip and alveolus.
The prevalence of dental caries was 88.8% in children aged 5-8 years. By age, the prevalences were 66.7% for 5 years, 81.0% for 6 years, 94.4% for 7 years and 94.1% for 8 years of age. There was an increase in prevalences until the age of 7 years. In comparison with the report on the survey of dental diseases (2005), children with these conditions showed higher rates of dental caries at all ages.
The average number of dft per persons and the rates of dft were 5.6 teeth (40.0%) in the 5-8 age range. By age, the values increased from 3.2 teeth (18.1%) to 5.1 teeth(33.8%)and 6.3 teeth (46.7%) from 5-7 years of age. At 8 years of age, the figures were 5.5 teeth (45.1%), which was a slight decrease.
The rates of dft for maxillary teeth on the whole was 42.6%. By tooth type, the rate was highest at 57.1% for deciduous first molars followed by 50.0% for deciduous second molars, 35.0% for deciduous lateral incisors, 34.8% for deciduous central incisors and 27.7% for deciduous canine teeth. The rates of dft for mandibular teeth overall was 37.0%. By tooth type, the rate was highest at 57.1% for deciduous first molars followed by 48.1% for deciduous second molars, 13.8% for deciduous canine teeth, 6.5% for deciduous lateral incisors and 0.0% for deciduous central incisors.
With the exception of maxillary deciduous central incisors, in maxillary teeth as a whole, deciduous first molars and mandibular teeth as a whole, patients with cleft lip and palate showed significantly higher rates of dft than in the survey of dental diseases.

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A questionnaire on the orthodontic treatment in patients with cleft lip and palate was developed with the intent of using it in an intercenter collaborative study and an investigation was conducted in the University of Tokyo Hospital (UTH). The questionnaire was sent by mail to 36 patients with unilateral cleft lip and palate who had received orthodontic treatment. Twenty-five patients responded and the response rate was 69.4%. Following findings were obtained from this study.
1) For the most part, surgeons or speech therapists provided information about orthodontic treatment.
2) The main reason to consider orthodontic treatment was poor teeth alignment, but many patients also complained of speech difficulties. The most highly anticipated effect was aesthetic improvement in teeth alignment or in facial appearance.
3) Many patients experienced pain as well as difficulties in chewing, speech and brushing their teeth during orthodontic treatment.
4) All patients answered that the alignment of the anterior teeth had been improved after treatment, and about two thirds of the patients answered that their facial appearance had been improved. More than 80% of the patients answered that they could chew better and about 80% answered that they could speak more easily.
5) All patients responded that they were satisfied with their orthodontic treatment.
6) More than 70% of the patients claimed that the burden of going to the hospital had been heavy.
7) Answers about the contents of treatment such as alveolar bone grafting, orthognathic surgery, orthodontic appliances and dental management after orthodontic treatment were considered to have poor reliability.
These findings indicated that most patients treated in UTH were satisfied with the outcome of their orthodontic treatment and that orthodontic treatment also had a positive effect on their speech. However, room for improvement was found in oral hygiene and in treatment efficiency.

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We performed a two-stage closure of a cleft palate in the complete unilateral cleft lip and palate. The cleft lip was closed at six months of age without closure of the alveolar cleft. Just after the soft palate cleft was closed at approximately 18 months of age, a speech plate was placed on the remaining cleft of the hard palate. The remaining hard palate and alveolar cleft was closed with local mucoperiosteal flaps at approximately 10 years of age. Autogenous bone was grafted to the alveolar cleft at the same time. The purpose of this study was to observe the postoperative grafted bone height at the alveolar cleft and to identify factors regarding the bone resorption. Sixteen patients received a bone graft operation by the same surgeon. Dental radiographs were taken just before and after the bone graft, and every six months until three years after the surgery. The postoperative resorption of the alveolar bone level at three years after the bone graft was classified as slight, medium or severe according to the length of the adjacent teeth. Postoperative slight, medium and severe resorptions were observed in 13 patients (81%), two patients (13%) and one patient (6%), respectively. However, the postoperative bone bridge formation was clinically acceptable in all cases. In the patient with severe resorption, the preoperative ratio of the incisor tooth root length to the alveolar bone height was lower than those in the other patients. The postoperative alveolar bone resorption showed no significant relationship with the alveolar cleft width, donor site for bone harvesting and canine eruption.
In conclusion, this two-stage closure is good for alveolar bone grafting. It is important to maintain a good alveolar bone height of the adjacent teeth for successful alveolar bone grafting.

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Three cases of median cleft of the upper lip were treated in our department during the 14-year period from April 1995 to March 2009.
The first was a rare case of true median cleft, with a slight median notching of the lip, two upper labial frenums, two polyp- like projections of the left nostril and a small tumor of the roof of the nose.
The second was a rare case of true median cleft, with a pit of the philtrum and hypertrophy, two upper labial frenums, and alveolar bone notching at the mid- premaxilla.
Correction of the upper lip deformity at five months and three months respectively, was done by frenulectomy.
The third patient had a false median cleft of the upper lip thought to be a DeMyer IV type.
We operated at seven months, but the patient died about three months later from the surgery.

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The Goslon Yardstick Japan Seminar, a training course for the evaluation of dental arch relationships in patients with unilateral cleft lip and palate was held in April 28th-30th, 2009 in Tokyo. In this course, Dr. Michael Mars was invited as a lecturer from the Great Ormond Street Hospital in London, UK. The number of delegates was more than one hundred from a wide variety of specialist. As this was a training course, it was considered that there were large biases in the selection of models evaluated. The result showed that the dental arch relationships in Japanese patients were not so good in total. However, better results were found in some hospitals. We hope that this seminar would contribute to the improvement of the treatments for patients with cleft lip and palate.

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