Today, many aspects of the growth and developmental change of maxillofacial form and function in patients with cleft lip remain unexplained. Precise understanding of the relation between form and function in maxillofacial components in a growing patient might help to indicate more effective intervention and treatment timing. This study examined 5-9-year-old patients with unilateral cleft lip and unilateral cleft lip and alveolus who had undergone cheiloplasty during infancy. We took 3D facial morphological measurements and conducted an occlusal relation evaluation （5-Year-Olds’ Index） for morphological evaluation. Moreover, we took measurements of lip pressure, tongue pressure, and masticatory efficiency rates as functional indicators to evaluate their relations. The results showed that 3D facial morphological measurements revealed no significant difference by age. Regarding occlusal evaluation, the average score of 5-Year-Olds’ Index was 1.73. Regarding functional evaluation, average scores of lip pressure, tongue pressure, and masticatory efficiency rate were, respectively, 2.21kPa, 20.09kPa, and 16.02mg/s. In terms of correlation related to 3D facial morphology, occlusal relation and oral function, significant correlations or relations were found between （1） the angle of the angulus oris and 5-Year-Olds’Index, （2） the ratio of the cupid bow vertex and lip pressure, and （3） the red appearance area of the lip and masticatory efficiency rate. These results revealed a certain correlation between maxillofacial form and function for patients with unilateral cleft lip and palate in growth.
【Introduction】The medical support needs of parents of children with cleft lip and/or palate may vary with the child’s developmental stage. Therefore, parents may not always receive the medical support they expect. Support needs may also differ between mothers and fathers. However, few studies have investigated the support needs of fathers of children with cleft lip and/or palate. 【Objectives】This study aimed to examine the support expected by fathers of children with cleft lip and/or palate and the support they actually received from medical staffs. We identified suggestions for enhancing available support. 【Methods】We recruited fathers of children with cleft lip and/or palate （aged under 12 years） during regular visits to an outpatient clinic in a Japanese hospital between October 2015 and February 2016. We distributed anonymous questionnaires regarding the types of support expected by fathers and the support actually received to 235 participants who were waiting for their consultation. Completed questionnaires were posted in a lockbox in the waiting area or returned by mail within 1 month. 【Results】Valid responses were received from 105 fathers （valid response rate 44.7％）. The types of support expected by most fathers were: “Explanations about the treatment and operation so as to be easily understood by a parent,” “Concrete advice such as postoperative attention or meals,” and “Concrete advice about lactation and weaning before the operation.” Our comparison of expected and actually received support showed that most fathers actually received the types of support they expected. However, fathers reported that disappointing types of support were: “Technical explanation and instructions to kindergarten or school,” “Guidance on medical expenses and the medical system,” and “Advice when parents are asked about their child by a relative or friend.” 【Conclusion】Most fathers actually received the types of support they expected, which suggests that medical staffs generally offer appropriate support that meets the needs of fathers. However, many fathers were disappointed with support they received in terms of the medical institution’s cooperation with kindergartens or schools, and advice about medical expenses and communication with key people. We will examine the needs identified by fathers in more detail in future, which may inform improvement of available support.
This study was conducted to clarify the speech results after palatoplasty by the modified Furlow’s method. Post-operative results of fistulas, velopharyngeal function and articulation disorders of 52 subjects （BCLP: 11, UCLP: 11, CHSP: 15, CSP: 19） performed by the modified Furlow’s method at 9-20 months of age were investigated. The results were as follows: （1）Fistulas were observed in 3 cases （5.8％）. （2）49 cases （94％） attained good velopharyngeal function. （3）Articulation disorders were observed in 20 cases （38.4％）, and they required articulation training. （4）Among those patients, 12 cases （23％） had substitutions, 7 cases （13.4％） had palatalized articulation, 2 cases each （3.8％） had lateral articulation and glottal stop, and 1 case （3.8％） had nasopharyngeal articulation. （5）The rate of expression of lateral articulation was low, similar to the results of several previous studies. This result suggested the involvement of the characteristic of Furlow’s original method that mucosal defects in the hard palate are slight and suppress maxillary growth to a lesser extent.
We have performed two-stage palatoplasty for patients with cleft lips and palates in the Oral and Maxillofacial Surgery Clinic of Niigata University Medical and Dental Hospital since 1983. As a result of evaluating maxillary growth, we have changed the timing of hard palate closure from 5.5 years of age to 4 years of age since 2010. To validate the earlier hard palate closure in our two-stage procedure, we evaluated speech outcome at 4, 5, and 6 years of age. At 5 years of age, the cases with good velopharyngeal function increased significantly and the palatalized articulation was significantly reduced due to the earlier hard palate closure. Based on an evaluation of maxillary growth and speech outcome together, we conclude that earlier hard palate closure is reasonable for our two-stage procedure.
Alginate impressions have been used to fabricate palatal plates and Hotz’ plates for presurgical infant orthopedics （PIO） of cleft lip and/or palate （CLP） patients. However, general care of the whole body is essential in CLP infants since there is a severe risk of vomiting and aspiration while taking an impression. Recently, optical impression has become popular and we have used intraoral scanners in PIO. However, all commercially available intraoral scanners are developed for dentulous cases but not for edentulous infant cases with a large amount of saliva and body movement during scanning. To realize more efficient scanning, we thought it was necessary to obtain basic information, and so we examined the effect of various conditions on the time and accuracy of scanning. In this study, a resin cast model of a 40-day-old cleft lip and palate infant （sizes of alveolar and palate clefts were 3.0 and 11.5mm, respectively） was used. Optical scanning was carried out by using an intraoral scanner with a small wand. During the scanning, the following effects were examined: 1） wetness of cast model surface, 2） three-dimensional moving of the cast model, and 3） application of landmark on the alveolar cleft. The wetness and movement of the cast model did not have any effect on accuracy but significantly prolonged the scanning time. In contrast, the application of the landmark on the alveolar cleft significantly reduced the scanning time without affecting accuracy. These findings suggest that application of the landmark on the alveolar cleft is effective in oral scanning of CLP infants, and it is important to manage saliva and body movement of infants during scanning.
Various difficulties are related to the effects of cleft lip and palate. Among these, difficulty using words can cause communicative disorders that strongly and adversely affect individual quality of life （QOL）. Nevertheless, earlier studies have not adequately investigated factors related to the occurrence of palatalized articulation in people with cleft lip and palate. Using objective evaluation indices comprehensively from the viewpoint of phonetic linguistics, this study was conducted to clarify relations between the occurrence of palatalized articulation and the palatine form, occlusal relation, and velopharyngeal closure function. This study examined 36 patients with unilateral cleft lip, alveolus, and palate who received care and management at the Cleft Lip, Alveolus and Palate Center, Tohoku University Hospital. The palatine form was measured three-dimensionally by scanning the dentition model of each patient at 4-5 years old using a non-contact three-dimensional measurement device and three-dimensional measurement software. Occlusion evaluation and velopharyngeal closure function testing were used to investigate the relationship with the occurrence of palatalized articulation statistically. The following results were obtained. （1） Palatine form measurement The length, width, height, surface area, and volume tended to be smaller in the palatalized articulation group than in the normal articulation group. Significant differences were found particularly in the width and height at the back of the palate. （2） Occlusion evaluation In more than half of the palatalized articulation group, occlusion was poorer than in the normal articulation group. Palatalized articulation and deterioration of molar buccal occlusion occurred more frequently on the affected side. （3） Velopharyngeal closure function evaluation Most patients showed good function in both groups. No significant relation was found with the occurrence of palatalized articulation. These results suggest that narrowing （reduced width） and shallowing （reduced height） at the back of the palate are associated with deterioration of molar buccal occlusion on the affected side and are strongly related to the occurrence of palatalized articulation. These study results are expected to improve the individual QOL of patients by improving the treatment of patients with cleft lip and palate.
The present case report describes the long-term management of a case with bilateral cleft lip and palate. After surgical repositioning of the protruded premaxilla, root malformation was seen in the permanent incisor. After tooth transplantation and orthodontic treatment, a satisfactory occlusion without root resorption of the transplanted tooth was seen. The patient was a boy aged 3 years and 7 months with the chief complaint of protruded maxillary teeth. Surgical repositioning of premaxilla was performed at 4 years and 9 months old and secondary alveolar bone graft was performed for both sides at 8 years and 8 months old. After surgical repositioning of the premaxilla root, malformation of the maxillary left central incisor was seen and the mandibular left first premolar was transplanted at 12 years and 4 months old. After orthodontic treatment by a multibracket appliance, retention was initiated from 15 years and 8 months old. After all these treatments, facial appearance was improved and an acceptable occlusion was obtained. There was no root resorption or mobility of the transplanted tooth at 11 years after the transplantation.