We investigated the timing of acquiring the articulation of consonants ［p, k, t, ɕ, s, ts］, and the speech outcome at 5 years of age for 31 cleft palate patients who had undergone palatoplasty at Kyoto University Hospital from 2003 to 2008 and regular clinical management by speech therapists.
The results were as follows:
1. The patients who had not required speech therapy acquired the consonants in the same order ［p, k, t, ɕ, s, ts］ and at almost the same age as the children without cleft palate.
2. The speech outcome at 5 years of age was as follows:
Articulation: normal articulation was 70.9％, palatal articulation and lateral articulation were 12.9％, glottal stop and delayed articulation acquisition were both 6.5％.
Velopharyngeal function: Excellent accounted for 54.8％, Good for 32.2％, Fair and Poor for 6.5％.
3. Most patients who had acquired ［p］ within 1 year after palatoplasty had Excellent or Good velopharyngeal function, while some patients had delayed acquisition of alveolar consonants ［t, s, ts］ and had articulation disorder at 5 years of age.

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The purpose of this study was to elucidate the relationship between 5-year-olds’index evaluation and dentofacial morphology in unilateral cleft lip and palate patients using longitudinal data.
The subjects consisted of 48 unilateral cleft lip and palate patients （male: 31, female: 17） who were treated and maintained until completion of their permanent dentition at the Tohoku University Hospital Cleft Palate Center. Of 48 patients, 3 were rated score 1, 7 were rated score 2, 22 were rated score 3, 13 were rated score 4, and 3 were rated score 5. The mean score was 3.13. The subjects were divided into three groups: group A consisted of 10 patients rated score 1 or 2; group B consisted of 22 patients rated score 3; group C consisted of 16 patients rated score 4 or 5. Dental casts and lateral cephalograms taken at the time of primary dentition （4.9±0.5 years old） and at the time of permanent dentition （13.6±1.1 years old） were used. Model analysis was used to evaluate occlusion and dental arch widths and cephalometric analysis was used to evaluated antero-posterior positions of jaws and upper and lower incisor inclinations. These data were compared with control and correlations with grouping （score） were examined.
Both anterior occlusion and posterior occlusion in the permanent dentition were poorer in the groups of larger scores. Maxillary widths were mostly smaller than their corresponding controls in both dentitions and the widths in the permanent dentition were smaller in the groups of larger scores. SNA, SNB, and incisor inclinations were smaller than their corresponding controls in both dentitions. SNA in the primary dentition and ANB and A-B plane angle in both dentitions were correlated with grouping （score）. There was no correlation between dentofacial changes and grouping （score）. Treatment intervention tended to increase in the groups of larger scores.
The 5-year-olds’index evaluation reflects the antero-posterior maxillary position and jaw relationship in the primary dentition. It also reflects the antero-posterior jaw relationship and occlusion in the permanent dentition. The 5-year-olds’index is not only useful for evaluating primary operations but also for determining the prognosis of unilateral cleft lip and palate patients.

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The cases of patients with cleft lip and/or palate （CLP） who were treated at the Department of Orthodontics, Matsumoto Dental University Hospital, were clinico-statistically compared between two 10-year periods （first period: 1995 to 2004; second period: 2005 to 2014）.
1.In total, 183 and 149 CLP patients were treated during the first and second periods, respectively.
2.The patients’ cleft morphology was as follows. First period: unilateral cleft lip and palate （UCLP）, 87 patients （47.5%）; cleft palate （CP）, 33 patients （18.0%）; bilateral cleft lip and palate （BCLP）, 33 patients （18.0%）. Second period: UCLP, 65 patients （44.3%）; CP, 32 patients （21.0%）; and BCLP, 25 patients （16.8%）. Patients with UCLP or CP accounted for high proportions of the CLP patients during both periods.
3.The mean age of the patients at the first visit was significantly higher during the first period （8 years and 6 months） than during the second period （6 years and 6 months）.
4.As for the source of referrals to our hospital, the Department of Plastic & Reconstructive Surgery, Shinshu University School of Medicine （Shin Univ）, accounted for 50.3% of referrals, and the Department of Plastic Surgery, Nagano Children’s Hospital （Child Hos）, was responsible for 15.3% during the first period, whereas during the second period Shin Univ accounted for 32.9% of referrals, and Child Hos for 49.0%. These two hospitals were responsible for high proportions of the referrals to our hospital during both periods.
5.The distribution of the CLP patients’ homes was as follows: 60 patients （36.1%） lived in Matsumoto district, and 31 patients （16.9%） lived in Suwa district during the first period, whereas 68 patients （45.6%） lived in Matsumoto district and 34 patients lived in Suwa district （22.8%） during the second period. High proportions of the CLP patients lived in the central area of Nagano Prefecture in both periods.
6.Regarding the classification of crossbite, type 2 （total cross bite） crossbite was most common （34.4%）, and type 4 crossbite （anterior crossbite） accounted for 18.6% of cases during the first period, whereas type 4 crossbite was most common （38.9%） and type 2 accounted for 14.1% of cases during the second period. The frequencies of total and anterior crossbite decreased and increased, respectively.

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Diseases in the maxillofacial area are associated with otolaryngology, plastic surgery and oral surgery and so on. It is often the case that multiple departments are involved in the treatment, especially in difficult cases. It is also not rare that several departments treat the same type of disease, namely ‘boundary area’ for each specialty. In order to remove this boundary area, we launched the Craniomaxillofacial Center three years ago. In this study, we examined the achievements of our Center in these three years.
A retrospective chart review was done of the 180 cleft lip and/or cleft palate patients who visited our Center in the past three years. More surgeries were done in secondary cases than in the primary cases. Lip correction and open rhinoplasty were the dominant surgical methods. With regard to the cases located in the islands of our prefecture, periodical medical care was provided by the staff of our Center with a local medical support team. The quality of the treatment and follow-up in these islands was maintained at the same level as at our Center.

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Wolf-Hirschhorn Syndrome （WHS） was first described by Cooper and Hirschhorn in 1961, and by Wolf in 1965. The syndrome is caused by terminal deletion of the short arm of chromosome 4 （4p－） and is well known; the patient is usually diagnosed in childhood because of unique facial dysmorphism, cleft lip and palate, congenital heart disease, skeletal anomalies, and seizures.
We report a WHS patient who has a cleft lip and palate, and whom we have been following for a long time. The woman is now 30 years old, and has undergone cheiloplasty for bilateral cleft lip and palatoplasty. We used the von Langenbeck method rather than the pushback method to prevent airway obstruction. We have been following her progress for more than 30 years after the surgery. It is considered that WHS patients cannot reach adulthood if they have a cardiac abnormality, but our patient has a congenital heart malformation. A WHS adult with such a heart malformation is very rare. It is important to follow up their oral hygiene for a long time and to consider the risk of aspiration pneumonia and infective endocarditis.

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