We investigated speech outcomes in 80 patients with submucous cleft palate assessed by the Oral and Maxillofacial Surgery Clinic and the Speech Clinic in Dentistry at the Niigata University Medical and Dental Hospital from 1982 to 2012. Of the 80 patients, there were 60 patients in the surgically treated group and 20 patients in the non-surgically treated group.
The results were as follows:
1) In the surgically treated group, the velopharyngeal function evaluated after palatoplasty (an average of 2 years postoperatively) was good (good＋fairly good) in 36 patients (63.4%). When we examined the association between age at palatoplasty and velopharyngeal function, the velopharyngeal function evaluated postoperatively was good in almost all of the 1-year-old children, but poor (fairly poor＋poor) in more than half of the children over 5 years of age. When we examined the association between mental retardation (MR) and velopharyngeal function, the MR group tended not to have better outcomes than the non-MR group.
2) In the non-surgically treated group, there was no clear change before and after treatment.

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【Introduction】 In recent years, the importance of children’s point of view in understanding diseases and providing treatment in everyday life has been recognized. It is necessary that children with cleft lip and/or plate are understood, because these diseases are highly prevalent among diseases in children, cause visible transformation and require long-term treatment. Especially, adolescent patients are at risk of lowered self-esteem when they undergo cleft lip revision.
【Objects】 This study aimed to clarify the attitudes of adolescent patients with cleft lip and/or palate and treatment, and to provide suggestions for appropriate support.
【Methods】 Semi-structured interviews were held with nine adolescent patients with cleft lip and/or palate. The results were analyzed qualitatively. Based on verbatim interview transcripts, each sentence that was considered to be meaningful pertaining to the cleft lip and/or palate and treatment was labeled using a code, then subcategories and categories were generated.
【Results】 Negative attitudes expressed were: “I cannot recognize my cleft lip and/or palate treatment as my own problem”, “I cannot avoid being treated”, and “I have to adapt to limits and changes associated with treatments”. Positive attitudes expressed were: “I think that oneself with cleft lip and/or palate is oneself”, “I will receive treatment for myself”, “I want to understand cleft lip and/or palate”, and “I use the treatment as an excuse to skip school”. Adolescent patients formed their opinions on cleft lip and/or palate and treatment while being influenced by evaluations from people other than themselves.
【Conclusion】 The results suggested that adolescent patients were in the process of discovering the significance of their birth and life with cleft lip and/or palate. They had both negative and positive attitudes toward their cleft lip and/or palate and treatment. The negative expressions were associated with the absence of their treatment decision-making process; for instance, some patients felt happy with their preoperative appearance, but underwent corrective surgery because of recommendations from their parents and doctors. It is important to consider negative attitudes of adolescent patients with cleft lip and/or palate while medical staff support them through their decision-making process.

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Clinical statistical analyses were performed on patients with cleft lip and/or palate (CL/P) at the Orthodontic Clinic of Kyushu University Hospital from August 1970 to December 2012.
The results of analyses were as follows:
1. The number of CL/P patients during the 43 years studied was 1,844 (973 males and 871 females), and accounted for 10.02% of the total number of patients registered at the Orthodontic Clinic.
2. The age of new patients at our clinic ranged from zero years old to 45 years old. The most common age of beginning treatment at our clinic was three years old.
3. The types of cleft lip and/or palate were distributed into four categories, with 53.9% having cleft lip and palate, 20.1% with cleft palate, 19.3% with cleft lip and alveolus, and the remaining 6.7% having cleft lip.
4. Most of the CL/P patients lived in Fukuoka prefecture, especially Fukuoka city and its neighboring towns.
5. Arch form in the patients with unilateral cleft lip and palate (UCLP) was classified according to the Pruzansky and Aduss classification, with 21.2% falling into the overlap type, 70.6% into the contact type, and 8.2% into the free type.
6. Cross-bite type in UCLP patients was classified into six types: type 1 at 26.7%, type 2 at 43.1%, type 3 at 4.2%, type 4 at 9.5%, type 5 at 10.9%, and type 6 at 5.6% using Kohno’s method.
7. The mean scores of occlusal evaluation were 3.09 using the Five-Year-Olds’ index for primary dentition, and 2.90 using the Goslon Yardstick in late mixed dentition.

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An important aim of secondary alveolar bone grafting is alignment of teeth into the bone bridge during orthodontic treatment. When the maxillary lateral incisors are missing, unerupted canines situated at the posterior of alveolar clefts may spontaneously move into the grafted area after bone grafting. On the other hand, erupted canines may migrate into the bone bridge with orthodontic treatment. In both cases, dental rehabilitation does not use any prostheses. However, relapse of the dental arch may be observed long after orthodontic treatment.
We report a 36-year-old patient with unilateral cleft lip and palate who maintained an ideal dental arch without prostheses for about 10 years after orthodontic treatment, but her occlusion gradually developed into anterior cross bite. Thus, she underwent additional orthodontic treatment in order to improve anterior cross bite and reserve space for lateral incisors on the bone bridge. After improvement of anterior cross bite, she was treated with an implant prosthesis, and her dental rehabilitation was satisfactory.
She had undergone alveolar bone grafting at age 7 years and 4 months, and orthodontic treatment had finished at age 21 years. During her dental rehabilitation, because of congenital missing left lateral incisor, the left canine was aligned at the left central incisor. Although periodic follow-up continued, anterior cross bite developed gradually. She therefore underwent additional orthodontic treatment at age 32 years. The width of the opened bone bridge was 5–7 mm from the buccal side to the palatal side, and showed a vertical height of 11 mm on X-ray computed tomography. After implantation of the fixture, her prosthetic dental rehabilitation was satisfactory at age 35 years.
Based on this case, dental rehabilitation with specific treatment goals may infrequently result in unplanned long-term changes. Thus, the bone bridge, which maintains stable dentition, comprises rich bone tissues and is subsequently capable of supporting orthodontic treatment with an implant prosthesis. Our experience suggests that patients with cleft lip/palate should be followed for long periods of time whenever possible.

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Amputation neuroma is a benign tumor formed by the proliferation of Schwann cells, axons and connective tissue elements. It is secondary to the partial or total section of a nerve pathway due to an accidental or surgical trauma. Amputation neuromas are found at any site and affect any type of nerve. The presence of amputation neuroma is very frequent in major surgery but rare in simple excisions of skin. We report a case of amputation neuroma in the upper lip developing after cheiloplasty.

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