We studied the effect and validity of medical intervention for submucous cleft palate (SMCP) in our center retrospectively.
Object: Fifty SMCP cases were referred to our center between April 1992 and December 2008. Of these SMCP cases, 36 were examined, and 14 with complications which affected operation and speech therapy were excluded.
Method: SMCP is defined as a congenital deformity in which there is imperfect muscle union across the velum, if they do not satisfy the Calnan's triad. Their gender, age at first visit, chief complaint, complications, Calnan's triad, length and mobility of soft palate, and medical interventions (operation and speech therapy) were investigated.
Results: There were 17 males and 19 females, and the age at first visit varied from 8 days to 6 years and 3 months. Chief complaints were morphologic defects such as cleft in 21 cases and functional disability such as speech disturbance in 15. Complications were found in 22 cases; chief complications were as below: mental retardation in 11 cases, 22 q 11.2 deletion syndrome in 4, first and second branchial arch syndrome in 4 (2 cases with auditory imperfections), and Robin's sequence in 3 (combined OSAS in one). Clinical symptoms were: imperfect muscle union across the velum in 36 cases, uvula bifida in 28, deficiency in the bone of the posterior edge of the hard palate in 22, and all of the Calnan's triad in 20. Eighteen cases showed short palate, and palatal lift was poor in 14 cases. Operation was necessary in 19 cases. In 17 cases without surgery, 12 required speech therapy. The effects of speech therapy were: improvement in 10 cases and slight improvement in 2. Satisfactory speech was acquired before starting school, excluding a case speech therapy was started after 5 years. In the operated cases, palatoplasty was performed. In one case, a pharyngeal flap was combined. In 15 cases speech therapy was necessary. The effect of medical intervention was: improvement in 12 cases, slight improvement in one, and no change in 2. For the 2 no-change cases, a PLP was applied in one, and a pharyngeal flap was applied additionally in the other. In 15 cases with surgery, excluding the 2 no-change cases and 2 cases operated after 5 years, satisfactory speech was acquired before starting school.
Conclusion: Excluding the 2 cases in which the speech evaluation after primary operation showed no change, the other cases could acquire satisfactory speech before starting school, provided medical intervention was started within 5 years. We conclude that the medical intervention in our center is appropriate.

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Background: Dermoid and/or epidermoid cysts are a relatively rare disease. The incidence rate of dermoid and/or epidermoid cysts of the oral area is about 0.01% among all cystic lesions in the oral cavity. We have treated many patients with cleft lip and palate since 1993 and met some cases diagnosed with dermoid and epidermoid cyst after lip plasty.
Subjects: We performed a retrospective study of 848 cleft lip and palate patients treated in Aichi-Gakuin University Hospital, Cleft Lip and Palate Center from 1993 to 2005. Seven patients developed a cyst on the upper lip after lip plasty and/or lip replasty operation, and their pathological diagnosis was dermoid or epidermoid cyst. We evaluated the association between the technique of lip plasty and the etiology of dermoid and epidermoid cysts.
Results: Seven patients were cleft lip cases (3 cases were cleft lip only, and 4 cases were cleft lip and palate). Regarding cleft type, 3 cases were bilateral and 4 cases were unilateral (the right side in one case, and the left side in 3 cases). All these cysts occurred near to the surgical site.
One case was diagnosed as a dermoid cyst, 5 cases as an epidermoid cyst, and one case as a mixed cyst. In 4 cases, a Santos flap was used in primary lip plasty.
Discussion: We suspect that the incidence of dermoid and/or epidermoid cyst is high when using a Santos flap. Upper lip cysts may occur as a complication after lip plasty.

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We performed a questionnaire survey regarding inter-disciplinary care teams and breastfeeding guidance for mothers of babies with cleft lip and/or palate. Responses were obtained from a total of 130 medical facilities performing surgery for cleft lip and palate and registered by the Japanese Cleft Palate Association. The following findings were obtained:
1. Approximately half of the facilities answered that less than 10% of mothers of babies with cleft lip and palate did not practice direct breastfeeding at the initial visit to the facility. However, approximately 30% of facilities failed to provide information on whether direct breastfeeding for the babies was performed.
2. Most facilities provided lactation guidance for mothers of babies with cleft lip and/or palate. However, about half of the facilities focused solely on methods of bottle feeding, such as how to select artificial nipples and how to use nipples for babies with cleft palate. Guidance on breastfeeding was given at 48% of facilities.
3. The nipple type most commonly recommended for mothers who experienced difficulty bottle feeding using usual nipples was the P-type nipple (72%), followed by the NUK type (39%) and the Chuchu type (34%).
4. After plastic surgery, 35% of mothers did not change their bottle feeding method from that used before the operation. In other cases, narrow-mouthed bottles, nutrition tubes, or spoons were used in order to allow the wound to heal normally.
5. A total of 82% of facilities answered that direct breastfeeding for babies with cleft lip and/or palate is feasible depending on the mother's situation, and 57% of facilities answered that assistance for mothers is necessary for the establishment of direct breastfeeding.
6. Important interventions for promoting direct breastfeeding for babies with cleft lip and palate included “advice from treatment team from immediately after birth” (64%) and “enhancing knowledge of breastfeeding guidance among obstetric staff” (48%); however, only 21% of facilities cooperated with maternity hospitals to implement these measures. Additional measures included “improvement of palatal plate” for direct breastfeeding (48%) and “improvement of artificial nipples” (33%).

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We report a patient with cleft lip and palate who refused to eat after secondary palatoplasty. The patient was a 5-year-old boy with multiple congenital anomalies (including auricular deformity, micropenis, and hypoplastic corpus collosum). Cochlear implants were placed for his hearing loss. The patient also had intellectual disability, communication disorder, and autistic tendencies. For his complete right cleft lip and palate, he underwent primary lip repair (triangular flap method) at 5 months of age and primary palatoplasty (push-back method) at 1 year and 3 months of age. The patient initially refused to eat postoperatively and required a few days to begin eating again, but his postoperative course was otherwise uneventful. Thereafter, he was periodically followed up at the Department of Plastic and Reconstructive Surgery, and he was unable to speak at 5 years of age. He was followed up at another institution for his hearing loss. At that institution, he was found to have velopharyngeal incompetence (VPI) and was recommended to undergo surgery at our department. We explained to his family that his inability to speak and VPI were unrelated, but they strongly desired the surgery. Therefore, a secondary palatoplasty (re-push-back method) was performed at 5 years and 4 months of age. The patient was given a liquid diet one day postoperatively but he refused to eat. Therefore, parenteral nutritional therapy was continued via a peripheral vein. Since his body weight decreased 1 kg by the tenth postoperative day, he was transferred to the pediatric department where tube feeding was initiated. His refusal to eat was thought to be of psychogenic origin, and the administration of an anti-anxiety drug (tandospirone citrate) was initiated on the 38th postoperative day. The patient and his family became accustomed to tube feeding by the 54th postoperative day, and he was discharged from the hospital because he was considered to be manageable at home. He began eating bread 1 week after discharge (61st postoperative day), and his dietary intake was good by the 70th postoperative day. Special considerations are thought to be necessary for secondary palatoplasty in pediatric patients with intellectual disability. It is important to carefully consider surgical indications and consult with the patient's pediatrician and physiatrist to reduce psychological stress caused by intraoral surgery.

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The prosthetic treatment of bone grafts to the alveolar cleft using dental implants is attracting attention as a useful therapeutic method that is not irreversibly invasive with cutting of adjacent teeth or overloading, as in the case of conventional fixed bridges. Reports on the long-term clinical course have recently appeared and the survival rate of the implants is high, about the same as that of implants in healthy bone. The main objective of final prosthetic treatment in patients with cleft lip, alveolus and palate (cheilognathopalatoschisis) is not only to provide a prosthesis covering a defect, but also to maintain the dental arch form improved by surgery or orthodontic treatment. The present study investigated three patients in our department who received implants for bone grafts to the alveolar cleft according to cleft type.

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