Since the Furlow method does not form a mucosa defect in the palate, it is a useful method that causes less inhibition of maxillary growth. However, it has been reported that fistula occurs at a frequency of 0-43% as a complication. It is important to determine whether the palate is closable during surgery and to avoid closing the palate mucosa with strong tension in order to prevent the occurrence of fistula. We have created a formula for calculating the closable maximum cleft width in order to determine whether direct closure of the palate is possible. In order to create this formula, the distance between the two maxillary tuberosities, cleft width at intertuberosity region, and distance from the line of the maxillary tuberosity to cleft edge (cleft height) were measured. The closable maximum cleft width was obtained by using the distance between the two maxillary tuberosities and cleft height, and applying them to the formula of the trapezoid. Then, a correction value was obtained by application to 46 cases of isolated cleft palate who underwent treatment in our hospital.
If the distance between the maxillary tuberosity is X, the cleft height is Y, and the closable maximum cleft width is Z, then
Z = X - {√(X²-4Y²)} + 0.27X
If the closable maximum cleft width is greater than the measured cleft width, it can be considered that the cleft can be closed. The reason why correction of the formula was necessary was considered to be the extensibility of the palatal mucosa, the palatal shape, the concavo-convex shape of the palatal shelf, and the difference between the right and left sides of the palate.

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We assessed the nasal shape in patients with unilateral cleft lip who underwent reverse U incision secondarily and compared the results with our original assessment sheet that was first published in 2007. Surgery was performed by a single surgeon from January 2000 to May 2010 (n = 29). Patients were categorized into one of the following three groups: group 1, cleft lip patients; group 2, cleft lip and alveolus patients; and group 3, cleft lip, alveolus and palate patients. Each group was assessed by the scoring sheet in both the preoperative and the postoperative period, and the scores were then compared. The scores of group 1 just before secondary rhinoplasties were significantly higher than those of group 3 (P = 0.039). The scores of group 3 after the secondary rhinoplasties worsened slightly during the follow-up when compared with group 1 (P = 0.048). However, the scores at final assessment in all groups were relatively similar. All cases experienced marked improvement in response to secondary reverse U incision. Further, this scoring method was very simple and effective for assessment of nasal deformity in patients with unilateral cleft lip.

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The purpose of this study was to examine the psychological state and concerns of guardians of patients with cleft lips/palates or alveoli while undergoing orthodontic treatment. The participants were 86 guardians of minor patients with cleft lips/palates or alveoli who were being treated in the Department of Orthodontics at Kagoshima University Medical and Dental Hospital and who filled out questionnaires provided by dental hygienists. The questionnaires were used to statistically evaluate the visual analogue scale (VAS) variations among five groups divided by patients' developmental stage (preschoolers, elementary school students aged 7-9, elementary school students aged 10-12, junior high school students, and high school students or older). The results of the questionnaires indicated that, when they realized their children required orthodontic treatment, most guardians displayed the psychological states of “sadness, anger, and anxiety,” and the majority felt “anxiety” about “requiring orthodontic treatment over a long period.” Additionally, the guardians were highly concerned about items related to aesthetics such as “facial appearance.” They were also highly concerned about “anxieties related to social life.” On the other hand, VAS scores for “period of orthodontic treatment” and “clinical time of orthodontic treatment” in the group of high school students or older were significantly higher than in preschoolers or elementary school students, suggesting that those items constituted a psychological burden. VAS scores for “problems caused by orthodontic appliances” were significantly higher in the group of elementary school students aged 10-12 than in the group of elementary school students aged 7-9. However, orthodontic appliances used on elementary school students aged 7-9 and 10-12 were nearly the same. These results suggested that guardians whose children underwent long-term orthodontic treatment were more likely to be burdened by these issues. In summary, the guardians of patients with cleft lips/palates and alveoli who were undergoing orthodontic treatment were particularly concerned about aesthetics. Additionally, the degree of anxiety or burden regarding the “period of orthodontic treatment” and the “clinical time of orthodontic treatment” was different for each of the development stages of the patients.

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In recent years, some reports on postoperative computed tomography evaluations of secondary bone grafting into the alveolar cleft have been published. Here, we report a retrospective study on the prognostic factors of bone bridge formation after secondary bone grafting into the alveolar cleft, evaluated with computed tomography.
In 13 cases, we evaluated the bone bridge formations at a total of 9 points: each of the 3 points of the buccal, central, and palatal sites in 3 different height slices of the central incisor in the cleft side (root tip, middle, and alveolar crest).
The frequencies of bone bridge formations were as follows: all cases in middle/buccal, 9 (69.2%) in middle/central, 8 (61.5%) each in root tip/buccal and alveolar crest/central, 6 (46.2%) in alveolar crest/buccal, 5 (38.5%) in middle/palatal, 4 (30.8%) in alveolar crest/palatal, and 3 (23.1%) each in root tip/central and root tip/palatal. Moreover, a univariate logistic regression analysis clearly showed that the preoperative width of the alveolar cleft could be a predictive factor of postoperative bone bridge formation in the central and palatal regions at the middle height of the tooth root.

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This study examined the relationship between velopharyngeal function evaluated using the Japanese Scale for Assessment of Cleft Palate Speech and velopharyngeal gap size evaluated using nasoendoscopic examinations or/and lateral cephalometric analysis. The subjects were 48 patients with a repaired cleft lip and palate. Forty patients had a cleft lip, alveolus, and palate, and 8 had an isolated cleft palate. They were suspected of having velopharyngeal inadequacy and were evaluated at the age of 4-7 years old from 2007 to 2013. All the patients with a cleft lip, alveolus, and palate had not undergone alveolar bone grafting. Velopharyngeal function was judged using the Japanese Scale for Assessment of Cleft Palate Speech on a 4-point scale: good, slightly impaired, marginally impaired, severely impaired. If the patients could not be judged according to this scale, they were classified as “pending judgment.” Gap size was assessed using the following 4-point scale: none, small, medium, large. Agreement between the 4-point scales of velopharyngeal function and gap size was determined using the weighted Kappa statistic.
The results were as follows:
1. Of the 48 patients, 29 (60.4%) could be judged according to the 4-point scale of the Japanese Scale for Assessment of Cleft Palate Speech; 19 (39.6%) were classified as “pending judgment” and all had an unrepaired cleft alveolus.
2. The level of agreement between velopharyngeal function evaluated using the Japanese Scale for Assessment of Cleft Palate Speech and velopharyngeal gap size evaluated using nasoendoscopy or/and lateral cephalometric analysis was interpreted as moderate and good, respectively.
3. Some patients whose velopharyngeal function was judged “good” showed small gaps on nasoendoscopic examinations. These patients showed no gaps on lateral cephalometric analysis; however, they had nasal snort.
4. Two experienced listeners separately analyzed audio speech samples. An evaluation of inter-rater reliability using the weighted Kappa statistic was performed. The agreement level was interpreted as moderate for hypernasality and good for nasal emission.
5. Nasal snort treatment, blowing examination and the relationship between “pending judgment” using the Japanese Scale for Assessment of Cleft Palate Speech and size of cleft alveolus and fistulas are some issues that require further investigation.

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We investigated 60 cases with pharyngeal flap operation in Shizuoka Children's Hospital. The cases were divided into cleft palate cases, submucous cleft palate cases and congenital velopharyngeal insufficiency cases, and the long-term results for each were compared and analyzed.
We found that:
1) In the evaluation at 1 year, about 90% of cases had improved postoperatively.
2) At the last evaluation, 90% or more showed the results of “good” or “very good”. There was no difference by type of disease.
3) The velopharyngeal function after pharyngeal flap operation was stable in the long term.
4) Some cases showed a slight change accompanying growth.
Although it was shown that the results where the pharyngeal flap surgery was stabilized also in which disease can be acquired from these results, many years past change was also accepted simultaneously. It is suggested that long-term observation of progress is necessary.

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A team approach is indispensable for the treatment of cleft lip and palate patients from newborn baby to adult. We established the Cleft Lip and Palate Center of the Maebashi Red Cross Hospital in 2009. We have a periodical center meeting which uses the treatment manual and clinical experience to improve the unity and cooperation of the team at the Center. We are able to offer a simple explanation of treatments to patients and families through our website and the annual parents' meeting. Furthermore, the creation of an in-hospital framework has reinforced cooperation throughout Gunma and led to progress in cleft lip and palate treatment. Cooperation between Gunma Children Medical Center and Gunma University Hospital has been strengthened, with various treatments being performed such as bone grafting and pre-nasoalveolar molding. The greatest difficulty in cooperation is with orthodontists, who are scattered in each area. Even if a question and/or problem exists between the operating doctor and the orthodontist, there was no opportunity to talk about it. To maintain the cleft lip and palate treatment policy of the prefecture, we hold a periodical conference for common cooperation. It is a part-time service. In addition, we have appointed an orthodontist who specializes in cleft lip and palate in the Maebashi Red Cross Hospital. This orthodontist coordinates between orthodontists and operating doctors, and is in an instructional position. We consider that we can improve the cleft lip and palate treatment regimen by increasing the cooperation between facilities and medical staff in future.

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We report the long-term stability of unilateral cleft lip and palate cases of palatoplasty using the push-back method after 12 years of treatment. As an example, we performed palatoplasty for a woman using the push-back method followed by orthodontic treatment. Initially, the patient had retracted maxillary, serious front stenosis of the maxillary dentition and severe crossbite. After the treatment, we could not observe the change in the anterior posterior relationship of the maxillary bone, but the crossbite had improved due to the lateral front enlargement of the maxillary dentition. At 12 years after orthodontic treatment, we did not see any skeletal change, but we confirmed the lingual inclination of the maxillary anterior teeth.

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A case in which a large alveolar cleft was treated with zygomatic implants in a patient with bilateral cleft lip and palate (BCLP) is reported. A 49-year-old female with BCLP was referred to our hospital because of a mastication disorder in February 2010. The initial closure of her lip and palate had been carried out at another institution, and she had not undergone orthodontic treatment or bone grafting. Due to the severity of the maxillary bone defect and the presence of an oronasal fistula, bone grafting for conventional dental implants could not be performed. Therefore, a treatment plan involving the restoration of masticatory function with zygomatic implants was established.
Under general anesthesia, we installed two implants between the molar region and the zygomatic bone through the lateral maxillary wall. The patient exhibited good masticatory and speech function after the installation of an implant supported prosthesis.
Our findings suggest that zygomatic implant therapy could be useful for BCLP patients who are not suitable for bone augmentation or conventional dental implants.

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