Unilateral cleft surgery should not be performed in a complex design at an early stage since reoperation at a later date will be difficult. I therefore devised a new surgical design using the triangular flap below the alar base and bow shaped incision in cleft edges. This paper explained detail surgical techniques of this surgical procedure. The postoperative suture line lose lateral scars and close to a straight line around the philtrum ridge. A long-term follow-up showed invisible operative scar. We believe that good external nasal growth is also observed.
The advantages of this method and supporting points to address the problems are discussed.

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The 5-Year-Olds' Index is considered to be a relatively simple and useful evaluation method; however, much remains unknown about its accuracy and reproducibility. We conducted a study on the accuracy and reproducibility of evaluations with this index.
In this study, evaluations were made by 21 dentists using standard models in a total of 10 cases, two each ((1), (2)) for each classification (Groups 1-5) in the 5-Year-Olds' Index distributed at a workshop held by the Japan Cleft Committee. Based on the results, weighted Kappa values were obtained for agreement with the correct responses and intra-rater agreement. In addition, we compared years of experience (A assessors: ≥ 10 years, B assessors: 2-9 years, C assessors: < 2 years) with the relationship of agreement with the correct responses. Agreement with the correct responses and tendencies for errors in evaluation were also examined for each standard model. Agreement with the correct responses (Kappa value) was “Very good” for A (0.83) and B (0.83) assessors, and “Moderate” for C assessors (0.53). Agreement with the correct responses was also compared by assessors' years of experience, and the results showed a significant difference between A and B assessors and C assessors (p < 0.05). The correct response rate for each of the standard models was the highest for Group 5-(1)), at 95.2%. The most common evaluation error was judging Group 3-(2) to be Group 4 (40.5%).
The standard models used in this study were appropriate as standard models for the 5-Year-Olds' Index. The results suggest that in order to raise the evaluation accuracy and reproducibility of the 5-Year-Olds' Index, it is necessary to provide thorough training on evaluation using the standard models and to increase opportunities for involvement in the treatment of children with unilateral cleft lip and palate. Repeated training for evaluation using the standard models is also considered to be important for correct assessment of the judgment criteria.

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Meikai University Hospital and Saitama University Hospital have cooperatively treated unilateral cleft lip and palate patients by presurgical infant orthopedics (started immediately after birth), surgical lip closure (Noordhoff flap performed at 4-6 months old), gingivoperiosteoplasty, and Furlow palatoplasty (performed at 12-18 months old). To evaluate the short-term treatment outcome, cast models and lateral cephalograms of five children with unilateral cleft lip and palate were examined at 4-5 years old. All five patients underwent presurgical infant orthopedics and surgery by the same dentist and surgeon. Cast models showed an anterior crossbite in four cases including one case with unilateral molar cross bite. All five cases showed that the arch width was narrow in the canine region, but this was not the case in the molar region. Two cases showed underdeveloped maxillae with small SNA values; however, the values of the other three cases were comparable to the Japanese standard. The antero-posterior evaluation of the mandible varied among cases and there was no common skeletal pattern, resulting in only one case with skeletal Class III malocclusion. Retroclined maxillary incisors were seen in three cases. Evaluated frontally, deviation was hardly seen in the maxillae, but the inclined occlusal plane and deviated mandible were seen in one case. This short-term evaluation demonstrates that skeletal Class III relationships with retruded maxilla and narrowed maxillary arch were hardly seen after the present treatment program.

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We report the mid-term results of a patient who underwent two-flap palatoplasty following presurgical nasoalveolar molding (NAM).
The patient was a child with left cleft of the lip, and the alveolar cleft width was 13mm on the first examination at 2 weeks after birth. NAM was initiated 3 weeks after birth, and rhinocheiloplasty (triangular flap + Millard method) was performed when the alveolar cleft became 0mm after NAM treatment for about 4 months, and palatoplasty (modified two-flap method) was performed at 1 y 1 m. No gingivoperiosteoplasty (GPP) was applied.
Since glottal stop was observed at 3 y 4 m after birth, speech therapy was initiated at an early stage. Glottal stop was resolved after speech therapy for about 6 months. On re-evaluation at 5 y 11 m of age, the morphology of the lips and nose was slightly asymmetric but favorable, the profile was straight, and the dental arch morphology was favorable with +1.5mm in both vertical and horizontal tegmenta in the oral cavity. Based on X-ray radiography, the patient was diagnosed as skeletal class I, the incisor on the cleft side was absent, and a bone defect was noted in the alveolar cleft region. The necessity of secondary alveolar bone transplantation was confirmed, but active orthodontic treatment is unnecessary at present, and the patient's progress is being monitored every 6 months. As of one year after the diagnosis, the esthetic, speech, and occlusal conditions were favorable.
The jaw development and oral cavity condition after two-flap palatoplasty were very favorable, suggesting that this surgical procedure exhibits a positive effect on jaw development and oral cavity morphology. Glottal stop was temporarily observed, which is particularly important. Further investigation of speech function and jaw development is necessary.

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We report two cleft lip and palate cases with congenitally missing upper lateral incisors on one side. In both cases, we improved the occlusion and facial profile with orthodontic treatment and auto-transplantation of the lower incisor without prosthodontic treatment. Case 1: A boy aged 8 years and 2 months, with a left-side cleft lip and palate. A narrow upper dental arch and an anterior crossbite to the molar teeth were observed. After using an expansion appliance to correct the occlusion, secondary bone grafting was performed. After performing the first stage of the orthodontic treatment with a sectional arch and during the observation period, the second stage of the treatment plan was planned and executed when the patient was 17 years and 3 months. The lower incisor was transplanted to the upper alveolar part of the missing tooth during the early stage of the fixed appliance. When the patient was 19 years and 4 months, the retention period was initiated. At 3 years and 10 months after the transplantation, the patient shows a good prognosis. Case 2: A girl aged 8 years and 7 months, with a bilateral cleft lip and palate. The premaxillary segment had shifted to the front and right side, and a severe deep bite, narrow upper dental arch, and an anterior crossbite to the molar teeth were revealed. After using an expansion appliance to correct the occlusion, premaxillary osteotomy and secondary bone grafting were performed. After performing the first stage of the orthodontic treatment with a sectional arch and during the observation period, the second stage of the treatment plan was planned and executed when the patient was 14 years and 11 months. The lower incisor was transplanted to the upper alveolar part of the missing tooth during the early stage of the fixed appliance. When the patient was 17 years and 1 month, the retention period was initiated. At 6 years and 8 months after the transplantation, the patient shows a good prognosis.

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