The purpose of this study was to examine the maxillary dental arch, the maxillary and the mandibular responses about the quantity of expansion and symmetry to rapid palatal expansion (RPE) in IIA, IIC and IIIA Hellman dental age stages.
Thirteen children (8 boys and 5 girls, average age 7.0 years) of unilateral cleft lip, alveolus and palate patients who required RPE treatment were included in this study. Pre- and post-RPE study models and posteroanterior (PA) cephalograms were taken for all patients. For each patient, on the pre- and post-RPE models, the widths between the deciduous canine, the deciduous first molar and the deciduous second molar were measured. In addition, PA cephalograms were traced, and a line running bilaterally through the Zygomatic suture point (Z) was indicated by a horizontal line, and a midline was indicated by a line perpendicular to the horizontal line through the crista galli. Transverse measurements were made between the midline and the following points. The measurement points were: the cusp of the deciduous canine, the deciduous first and second molar bilaterally, the mesial contact point of the upper and lower central incisors at the major segment, the Anterior nasal spine, the Menton, the Jugal process, the Nasal cavity, the Zygion, and Z. The bilateral measurement points were calculated by the ratio of the major segment to the minor segments.
The following results were obtained:
1. The mean increase of maxillary intercanine width and maxillary intermolar width were found to be 3.9-4.5mm in only two weeks, and which were about 60-70% of the screw expansion after RPE.
2. In Pre-RPE, maxillary intercanine and interfirst molar width of the minor segment region were significantly smaller than the major segment region, but there were no significant differences between these regions after RPE.
3. The midline of the maxillary and mandibular and facial symmetry did not change significantly after RPE.
It seemed that expansion using RPE at a deciduous and mixed dental arch for unilateral cleft lip, alveolus and palate patients was useful.

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In this study, lateral roentgenographic cephalograms of patients with unilateral cleft lip and palate was used, and the maxillofacial configuration in Hellman Dental age stages IIIA, IIIB, IIIC, and IVA before orthodontic treatment was analyzed. We consider that sharing common knowledge between operators (oral surgeons) and orthodontists leads to appropriate medical care with regard to the development of the jaw over continuous treatment of cleft lip and palate, for which development of a simple method of roentgenographic cephalometry to investigate the maxillofacial configuration may be necessary. Herein, we report our attempt to develop a new evaluation method (Goslon-cephalo method).
The subjects were 64 patients with unilateral cleft lip and palate before orthodontic treatment, who underwent cheiloplasty, palatoplasty, and continuous treatment in our department. The subjects were classified into 5 types based on our method, by performing lateral roentgenographic cephalometric analysis, and by evaluating maxillo-mandibular alveolar relationships using the Goslon-cephalo method. From the results obtained, we evaluated methods in which the necessity of surgical orthodontic treatment can be easily differentiated.
As for the results of frontal and lateral roentgenographic cephalometric analysis in each dental age stage, the Angle of convexity, A-B plane, and Gonial angle showed small values in stage IIIA. In stage IIIB, the Interincisal angle became large, and U1 to FH and U1 to SN presented small values, in addition to the characteristics observed in stage IIIA. Furthermore, L1 to the mandibular plane showed small values in stage IIIC.
In stage IVA, the Gonial angle showed large values, and gradually became larger between stages IIIA and IVA. Furthermore, ∠SNA decreased by more than -1 S.D. through stages IIIA and IVA.
Among the 64 cases, 12 cases (18.8%) were classified into a poor group (types 4 and 5) with a high potential to undergo surgical orthodontic treatment.
Based on the analytical results, the ∠SNA and ∠SNB were small throughout all stages in a favorable group (Types 1 & 2), showing a concordant maxillomandibular relationship. In contrast, in the poor group (Types 4 & 5), the ∠SNA was small throughout all stages, but variations were noted in the ∠SNB. It was suggested that these factors can be important indexes for occlusal control in continuous treatment.

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Objective: The aim of this study was to verify the association between dental caries and jaw development in patients with unilateral cleft lip and palate (UCLP).
Subjects: Plaster models were prepared for 27 subjects in an occlusion care (OC) group and 39 subjects in a non-occlusion care (NOC) group. The occlusal surface was photographed and various dental arch parameters were measured. A t-test was used for each variable to examine significant differences between the groups.
Results: The prevalence of dental caries in the OC group was lower than in the NOC group. The mean number of decayed-filled-teeth (dft) was 2.30 in the OC group, and 4.44 in the NOC group. There was no significant difference between the groups in the width and length of the maxillary and mandibular dental arches. The maxillary dental arch in the severe caries (SE-C) group and the slight caries (SL-C) group of the OC group was asymmetrical; however, it was symmetrical in the non-caries (N-C) group. The maxillary dental arches in the SE-C, SL-C and N-C groups of the NOC group were asymmetrical, whereas the mandibular arch was symmetrical in all groups. The tongue space volumes of the OC group and NOC group were similar. When compared to the control group, both groups showed significantly smaller values.
The highest rate of midline shift was seen in the SE-C group, followed by the SL-C group, the N-C group and the control group. The angle of the alveolar cleft in the anterior region in the SE-C group was significantly larger than in the SL-C group and the N-C group.
Conclusion: Our results revealed an association between dental caries and development of the jaw in patients with UCLP. It suggests that care of the occlusion at an early stage is necessary during treatment for UCLP.

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We experienced 183 cases of isolated cleft palate (59 in males and 124 in females) between1968 and 2003 in The Jikei University School of Medicine. The average age of the patients was 9.9 months (4 days to 11 years) at the first examination. Congenital anomalies were associated with cleft palate in 57 patients (31.1%; 21 males and 36 females). Of these 57 cases, 43 (13 males and 30 females) occurred in both the hard and soft palate and 18 (8 males and 10 females) in the soft palate. No congenital anomalies were found in the submucous cleft palate, tongue tie was found in 7 cases, inguinal hernia in 5 cases, congenital heart disease in 8 cases, anomalies of extremities in 12 cases, and mental retardation in 11 cases. Robin sequence and Apert syndrome were each found in 11 cases.

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Objective: The present study aimed to elucidate the involvement of environmental factors in the development of cleft lip and/or cleft palate (CL/P). We surveyed the lifestyles of pregnant women carrying infants with and without CL/P in Japan and categorized them into cases and controls. This study also included a few subjects from Lao.
Methods: We enrolled 24 Japanese mothers of infants with CL/P from the Cleft Lip and Palate Center, Ryukyu University Hospital (cases) and 22 Japanese mothers whose infants and family members were not affected by any congenital anomaly (controls). We also studied 26 mothers from Lao having infants with CL/P who underwent surgery in 2011. All subjects were provided questionnaires in their local language and were interviewed by the local staff after obtaining an informed consent. This survey was approved by the ethical committee of the University of Ryukyus.
Results: 1) In Japan, mothers having infants with CL/P were aware of their pregnancy 2.9 weeks earlier than mothers having infants without CL/P. 2) The average age of the Japanese mothers having infants with CL/P was 27.0 years, which is higher than that of mothers from Lao. 3) With regard to tobacco, alcohol, food, and drug habits during pregnancy, the survey results did not reveal any significant difference between the Japanese cases and controls.
Conclusion: The above findings suggest that identifying pregnancy at an early stage helps in changing one's lifestyle by controlling tobacco smoking and alcohol consumption, thereby allaying the development of cleft lip and/or palate.

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Congenital lip fistulas usually occur in the lower lip or in the angle of the mouth, but upper lip fistulas are extremely rare. We report a rare case of congenital lateral fistula of the upper lip and nose associated with a right side cleft lip. In this case, dimples in the right upper lip vermilion and ala were observed. At 6 months of age, a fistulectomy was performed with rhinocheiloplasty under general anesthesia. Histological examination showed that the fistula was lined by squamous epithelium. The postoperative course has been uneventful after a 3-year follow-up.

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Maxillomandibular osteotomy and modified maxillary distraction osteogenesis were simultaneously performed in a patient with unilateral cleft lip and palate. The patient was a male, aged 16 years 2 months, with maxillary under-growth and collapse of the maxillary dental arch. The chief complaint was reversed occlusion and crowding. Sagittal splitting ramus osteotomy of the mandible and Le Fort I osteotomy and anterior movement combined with the distraction osteogenesis of the maxilla were simultaneously performed after maxillary dental arch expansion had been performed as preoperative orthodontic treatment. An acceptable occlusion and good facial profile were achieved following postoperative orthodontic treatment and repair of secondary deformities of the nose and lip. The treatment period was 4 years 6 months. Although 6 years 6 months have passed since the completion of treatment and in 3 years 6 months since completion of retention, relapse of the expanded maxillary dental arch has not occurred. The occlusal result is stable, and no skeletal relapse can be detected.

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