Purpose: We investigated long-term changes in velopharyngeal function (VPF) and speech articulation in cleft palate patients who underwent initial palatoplasty at Shizuoka Children's Hospital.
Subjects: Of the 329 cases who received the first operation after 1989, we studied 104 patients (52 boys, 52 girls) who were able to undergo a regular medical examination from the age of four until 16 years old. There were 18 patients with bilateral cleft lip and palate (BCLP), 43 with lateral cleft lip and palate (UCLP), and 43 with isolated cleft palate.
Results: For VPF, any age showed the good result that 80-90% of patients did not need active treatment. On the other hand, a decrease of good closure function was observed in all cleft types over time. As for the presence and type of articulation disorder, a significant difference was observed according to the cleft type. There were some cases in which the articulation disorder had improved without speech therapy due to orthodontic treatments and alveolar bone grafting. In the patients having permanent articulation disorders, about half of them did not want to receive speech therapy, and all these patients showed palatalized or lateralized articulation disorder.
Conclusion: This investigation shows that the treatment results for cleft lip and palate patients seem to be stable on the whole. However, the results fluctuate with age in individual cases, and so long-term follow-up is necessary. Therefore, a multidisciplinary team approach in the same facility is necessary to enable the patients to receive ongoing medical examinations.

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Background: It is widely accepted that protocol management is important when treating patients with cleft lip and/or palate. Protocols should be established not only for perioperative care, but also for preoperative and postoperative management. However, there is no robust evidence regarding the level of preoperative screening required to facilitate safe primary surgery.
Methods: A retrospective chart review was performed by using the database and chart records of all patients who underwent primary cheilorhinoplasty at our center between April 2010 and March 2014. Data including the age, sex, cleft type, and associated anomaly were recorded. Congenital skin lesions such as umbilical hernia and accessory ear among others were not included as associated anomalies for this study. The remaining associated anomalies were subsequently evaluated, and classified into the following three groups:
1. Severe congenital anomalies that were treated or examined before our routine screening examination
2. Congenital anomalies that were unexpectedly detected during our routine screening examination
3. Anomalies that were not detected during our routine screening examination
Results: A total of 133 patients underwent primary cheilorhinoplasty during the study period. Most patients underwent routine preoperative screening, as per our protocol. Among those 133 patients, 5 had severe congenital anomalies that were treated or examined before our routine screening, 9 had congenital anomalies that were unexpectedly detected during our routine screening, and 4 had anomalies that were not detected during our routine screening.
Discussion: Uniform guidelines regarding preoperative patient screening are difficult to establish, because of the diverse cultural backgrounds, insurance systems, accessibility to a hospital, and human resources across many countries and regions. Nonetheless, as approximately 7% of patients who appeared healthy had some associated anomaly detected during our preoperative screening, this data should be considered when reevaluating the preoperative protocols in other medical centers.

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The speech prognosis of 28 patients 2 to 3 years after pharyngeal flap surgery performed at the National Center for Child Health and Development was evaluated. Velopharyngeal function was graded by 4 levels, and articulation errors related to velopharyngeal function were evaluated by 3 speech therapists at our Center. The operation was performed at the median age of 6 years (range: 3 to 14) . Speech therapy was performed in all the cases post-operatively. Ten patients were post-operative state of cleft palate, 9 were submucous cleft palate and 9 were congenital velopharyngeal insufficiency. Velopharyngeal function of all the patients was graded in the lower 2 levels before surgery. After pharyngeal flap surgery, velopharyngeal function was improved in all cases, and approximately 90% of patients were graded into the higher 2 levels, at which patients are thought to experience no problems in daily linguistic communication. Articulation errors were present in 12 cases pre-operatively, and decreased to 7 cases post-operatively. 22q11.2 deletion syndrome was present in 5 cases, and their velopharyngeal function was graded into relatively lower levels at 2 to 3 years post-operatively, but gradually improved at 4 years post-operatively. Mental retardation (IQ ≤ 70) was present in 9 cases, and their velopharyngeal function was graded into significantly lower levels compared to those without mental retardation at 2 to 3 years post-operatively. Pharyngeal flap surgery and speech therapy were effective treatments to improve velopharyngeal function and related articulation errors. Patients with 22q11.2 deletion syndrome require a longer period of speech therapy for improvement. A smaller level of improvement is expected in patients with mental retardation, probably due to difficulty in learning appropriate speech function.

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Alveolar bone grafting (ABG) has been widely used for patients with cleft lip and palate (CLP). However, its method, timing and outcome assessment vary among institutions. This study was designed to investigate the present status of ABG by a questionnaire survey. A questionnaire was distributed to 28 Japanese institutions attending "The Inter-center Collaborative Study" and 26 institutions (88%) responded. The questionnaire was made for unilateral CLP patients.
The questionnaire included 9 items about ABG: 1. patient's age, 2. department that determines the timing, 3. factors to determine the timing, 4. department which carries out ABG, 5. donor site, 6. the methods of outcome evaluation, 7. criteria for outcome evaluation, 8. treatment before ABG, and 9. problems in the management of ABG.
The average age at ABG was 8 years and 3 months. Orthodontists mainly decided the timing of ABG at most institutions. Eruption and root formation of the adjacent canine to the cleft side were used as indicators for the timing of ABG. Three institutions performed ABG before patients entered elementary school. ABG was done by both plastic surgery and oral surgery departments, followed by the plastic surgery department only. The iliac cancellous bone was employed for ABG in all institutions. The cortical bone from the chin was sometimes used in one institution. In almost institutions, outcome assessment was implemented by panoramic, dental and occlusal X-ray films. Some institutions used CT as well. Evaluation criteria varied among institutions.
These results are helpful for grasping the current status of ABG. Further development of mutual evaluation and exploration of proper assessment criteria will be essential to provide higher quality treatment for CLP.

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A statistical analysis of 148 patients with cleft lip and/or palate who visited the Department of Oral Maxillofacial Surgery, Nagoya City West Medical Center during the 26-year period from January 1988 to December 2013 was carried out.
The results were as follows:
1. The patients included 70 males and 78 females (total: 148) .
2. 79 patients (53.4%) were residents of Nagoya City.
3. 13 patients (8.8%) resided outside of Aichi prefecture (Gifu, Mie or Shizuoka prefecture).
4. The breakdown of cases by classification was:
58 cleft lip and palate (CLP) cases (39.8%) , 40 cleft palate (CP) cases (27.0%), 29 submucous cleft palate cases (19.6%), and 21 cleft lip (CL) cases (14.2%).
5. Among 79 CLP and CL cases, 52 cases (65.8%) were unilateral, and 27 cases (34.2%) were bilateral.
6. 39 cases (75.0%) were left-sided, and 13 cases (25.0%) were right-sided, with a ratio of 3 : 1.
7. Associated complicating malformations and/or disorders were observed in 64 patients (43.2%).

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The purposes of prosthodontic treatment in cleft lip and palate patients are to recover various functions, to prevent individual teeth and alveolar arches from relapsing, to equalize the occlusal force, and to close the fistula. The Department of Maxillofacial Prosthetics in Tokyo Medical and Dental University (TMDU) was established in 1979 as a Clinic for Stomatognathic Dysfunction and we have treated cleft lip and palate patients as a part of maxillofacial prosthetic treatment for 35 years since then. We report 4 cases that were treated in the early 1980s and were followed up with longevity for over 25 years.
Case 1: Left side of cleft lip and palate patient. An obturator and a hard resin facing fixed prosthesis were set as the abutment teeth were both maxillary central incisors, both maxillary canine teeth, and the left maxillary first premolar. The patient was followed for 31 years.
Case 2: Bilateral cleft lip and palate patient. An obturator, 2 plumpers and a hard resin facing fixed prosthesis were set as the abutment teeth were both maxillary central incisors, the right maxillary canine tooth, both maxillary first premolars and the left maxillary second premolar. The patient was followed for 29 years.
Case 3: Bilateral cleft lip and palate patient. An obturator, a plumper and a hard resin facing removable prosthesis by telescopic crowns were set as the abutment teeth were both maxillary central incisors, both maxillary canine teeth and the left maxillary first premolar. The patient was followed for 29 years.
Case 4: Left side of cleft lip and palate patient. An obturator, a plumper and a porcelain fused fixed prosthesis were set as the abutment teeth were the right maxillary central incisor, the right maxillary lateral incisor, the left maxillary canine tooth and the left maxillary first premolar. The patient was followed for 26 years.
In addition, individual teeth and alveolar arches were kept within normal limits in every case.

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Congenital lip sinus is a rare disease, which is believed to have an incidence of 0.001%. It occurs mainly in the lower lip and is extremely rare in the upper lip. The disease is also known to be complicated by other congenital anomalies, and a classification system exists that focuses on the sites of congenital lip sinus and the presence of other congenital anomalies. While various symptoms may occur, in many cases, no symptoms are apparent. We herein report a case of lip sinus in the midline of the upper lip, with reference to the literature.
A 17-year-old male patient had a depression in the midline of his upper lip at birth, which swelled greatly during the first year of life. An incision and drainage through the oral cavity was performed at a plastic surgery clinic, and the depression disappeared. Discharges were frequently observed thereafter. At the age of 17 years, he visited the outpatient department of our hospital mainly because of cosmetic concerns, and the lip sinus was successfully removed under local anesthesia.

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A seminar on the assessment of cleft palate speech hosted by the Japancleft Committee, Japanese Cleft Palate Association, was held at the University Hospital and the Sanjo Conference Hall, the University of Tokyo on January 31 and February 1, 2015. The purpose of the seminar was to increase awareness of the issues on standardized speech assessment among Japanese speech and language therapists and researchers in the field, and to propose a standardized system which is compatible with international approaches. A training protocol for valid and reliable assessment is to be developed, taking lessons from experiences in the UK and Ireland. Dr. Debbie Sell and Dr. Triona Sweeney, who developed the Cleft Audit Protocol for Speech-Augmented (CAPS-A) and a training package, were invited as lecturers at the seminar. The number of participants was 134, including 67 speech therapists, 57 dentists, and 10 plastic surgeons.
The questionnaire survey at the end of the seminar revealed that the importance of developing a standardized assessment system in Japan was fully recognized. From now on, efforts to develop a standardized assessment system will be continued by the working group in the Japancleft Committee.

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