Objective: To investigate current trends in primary treatment for children with cleft lip and/or cleft palate (CL/P) in Japan.
Design: Nationwide, retrospective study under direction of Academic Survey Committee of Japanese Cleft Palate Association (JCPA) based on analysis of data obtained via booklet-style questionnaire completed by institutions providing primary treatment for CL/P patients.
Participants, Patients: Patients were 4,349 children undergoing primary repair for CL/P at 107 participating institutions between 1996 and 2000.
Main Outcome Measure (s): Cleft type, laterality and extent of clefting, use of infant palatal plate and timing and technique of primary repair for CL/P were evaluated by cleft surgeons at 107 participating institutions.
Results: Out of a total of 2,874 patients with CLP or CP, infant palatal plates were used in 1,087 (37.8%) and not used in 1,787 (62.2%). Primary unilateral lip repair was performed at age of 2-6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2,212 (76.9%) and two-stage palatal repair in 262 (9.1%) of all cleft palate patients. Information on treatment in the remaining 400 (14%) patients was unavailable.
Conclusion: This investigation clarified current trends in primary treatment for CL/P in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.

View full abstract

The mucosal grafts and flaps method (MGF method) has been developed to minimize growth impairment of the maxilla following cleft palate repair. This study was conducted to clarify the speech results of the MGF method. Post-operative results of velopharyngeal function, fistulas and articulation disorders of 48 subjects (BCLP: 13, UCLP: 23, CHSP: 5, CSP: 7) operated by the MCF method at 12-22 months of age were investigated. It was confirmed that in all the subjects the mucosal grafts were stuck to the raw surface of the palate.
The results were as follows: (1) 46 cases (95.3%) attained good velopharyngeal function and two cases (4.2%) were borderline. (2) Small fistulas were observed in 2 cases (4.2%) but they needed no fistulectomy. (3) Articulation disorders were observed in 15 cases (31.3%) and hypernasality was observed in one case (2.1%). (4) Among the articulation disorders, “mis-palatalized articulation” was most frequent (11 cases), followed by forward distortion of velar and substitutions (3 cases each). Glottal stops or “lateral articulation” were observed in 1 case each. (5) These results of the MCF method were significantly better than those of the Palatal Mucosal Flap Method.
These results suggest that the MCF method is a recommended method not only from the viewpoint of growth of the maxilla but also from that of speech results.

View full abstract

The Goslon (Great Ormond Street, London and Oslo) Yardstick is a clinical tool that allows categorization of the dental arch relationships in the late mixed and/or early permanent dentition stage into five discrete categories, simply and reproducibly. Mars et al. and other experimental groups used plaster models to assess dental arch relationships. However, the Goslon Yardstick requires a number of dental models, and it is difficult to store. Many dental offices are adopting 3-dimensional digital models (3DD models) in view of their simpler storage and integration. The purpose of this study was to assess occlusal relationships in unilateral cleft lip and palate patients using 3DD models, and to compare the results with occlusal relationships using plaster models.
A total of 37 plaster models of unilateral cleft lip and palate patients in early mixed dentition were randomly selected and scanned to 3DD models. Four orthodontists with over 8 years of clinical experience assessed the occlusal relationship using plaster models or 3DD models twice for each tool with an interval of at least 5 days. Agreement of assessment was shown by weighted kappa value. The kappa values were characterized as follows: 0-0.20 as poor, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-0.80 as substantial, and 0.81-1.0 as good agreement.
The intraexaminers' reproducibility of occlusal relationship assessed by plaster models and 3DD models showed “good agreement” (kappa value: plaster models 0.82-0.91, 3DD models 0.77-0.85). The intraexaminers' reproducibility between plaster models and 3DD models was almost “good agreement”, too (kappa value: 0.75-0.86). Moreover, the assessments using 3DD models tended to be higher in value compared to those using plaster models.
Taken together, assessment of occlusal relationship by the Goslon Yardstick with 3DD models showed good agreement with that of plaster models. This indicates that 3DD models may be a suitable substitute for plaster models to evaluate dental arch relationships.

View full abstract

The permanent dentition at dental age IIIc described by Hellman, of patients with complete unilateral cleft lip and palate who underwent soft palate closure with Furlow's method (F-group), introduced with the aim of achieving better results of both speech and maxillary growth in two-stage palatoplasty, was compared to other patients who underwent Perko's method (P-group) and noncleft subjects (C-group).
The results were as follows:
1. Regarding the upper dental arch width, the distance between bilateral points of maxillary tuberosity in the F-group was smaller than that in the P- and C-groups. The arch width of the canine to premolar region was the same as that of the P-group, but slightly constricted compared to the C-group.
2. The upper alveolar arch length tended to be longer compared to the P-group, and the distance from the cuspid to the maxillary tuberosity line was longer than that of the C-group. There was no difference with the P-group regarding the upper dental arch length, but it was smaller compared to the C-group.
3. There was no difference with the C-group regarding the lower dental arch width, and only the width between the first molar of the P-group was larger than that of the F- and C-groups.
4. There was no significant difference among the three groups regarding the lower dental arch length.
5. While 2 of 17 cases (11.8%) had anterior or posterior cross bite, it was observed in 11 of 29 cases (37.9%) in the P-group.
Though there was a slight difference in the permanent dental arch form of the F-group compared to that of the P-group, reflecting the surgical method, there were no significant differences and the form was close to that of the C-group. The occlusal condition was not inferior to the P-group and good maxillary growth was obtained. Together with the improvement of speech results, it was considered that Furlow's method is useful for two-stage palatoplasty.

View full abstract