One of the significant aspects of academic conferences is that participants can obtain information on various diagnostic techniques, treatment procedures and implementations that can inform their own clinical practice. However, there are some participants in academic seminars who are passive listeners. During the 41st annual meeting, we decided to conduct an interactive questionnaire in a symposium using a Clicker Nano.
The topic of the symposium was “Aiming for the future of cleft palate treatment, things to know now”. The symposium also focused on unresolved problems in cleft palate treatment, local medical problems and the goal of speech therapy. The contents of the questionnaire focused on clinical profession, education, research on cleft palate treatment regardless of profession, years of clinical experience, and the number of treated cases. It also included feedback collected from the symposium on cleft palate treatment.
A total of 310 attendees participated in the symposium, of which 161 were orthodontists, 50 were plastic surgeons, 40 were oral surgeons and 59 were others （co-medical staffs, speech therapists, specialists and general dentists）. Among the participants, 24％ were highly skilled clinicians with more than 20 years of experience. There was a slightly higher percentage of participants who treated less than 30 cases （35％） and who treated more than 100 cases （38％）. The majority （68％） of the participants answered that conferences are the best place for calibrating practitioners’ potential. In regard to preoperative primary correction of deformity, 39％ used NAM, while 35％ used the Hotz plate. For palatoplasty, the most frequently used method was Furlow’s method （40％） followed by the push-back method （29％） and two-flap technique （11％）. In addition, we collected data on other questions regarding postgraduate education level and the proximity of treatment facilities.
Through this symposium, the current clinical situation, as well as problems concerning the treatment of cleft lip and palate, were clarified. In the future, the best and most progressive approach should be developed.

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Autologous iliac cancellous bone grafting in the alveolar cleft is used as a general treatment for patients with cleft lip and palate （CLP）. The thickness of the soft tissue and protrusion in the donor site of the ilium may affect the wound tension, which affects healing. In this study, to clarify the factors affecting wound condition, we evaluated the wound condition of the donor site, and investigated the correlation between the wound condition and the Rohrer Index （RI ＝ weight （kg） / height （cm）³ × 10⁷）.
The subjects were 62 patients with CLP who underwent iliac bone grafts in the alveolar cleft （72 sides, mean age 10.6 years） in our department from 2009 to 2016. The oral surgeons evaluated the wound healing using photographs of the donor site three months after the graft. The wounds were classified with a wound healing score from 1 to 5. Scores of 1 or 2 indicated good healing （good wound group）; a score of 4 or 5 indicated poor healing （poor wound group）. We also analyzed the correlation between the wound score and the age, weight, height, and RI of each patient using Pearson’s correlation coefficient. In addition, we compared the values of the good wound and poor wound groups using Student’s t-test. We obtained the following findings:
1．The good wound group included 35-41 （48.6-56.9％） of the 72 sides, and the poor wound group included 19-24 （26.4-33.3％） sides.
2．The mean RI of the good wound group was significantly higher than that of the poor wound group （good RI＝ 125; poor RI＝114; p ＜ 0.05）. Moreover, there was a moderate negative correlation between the wound healing score and the RI. There were no significant differences between other variables.
3．Cases with a low RI may have been due to insufficient subcutaneous tissue at the donor site; suture closure was more difficult and increased skin tension due to increased protrusion of the iliac crest. In conclusion, we suggest that a suture technique that relieves wound tension is necessary for infants with a low RI.

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In order to reduce the risk of vomiting and aspiration when taking alginate impressions, we are now using intraoral scanners for fabricating palatal plates in presurgical infant orthopedics （PIO） for cleft lip and/or palate （CLP） patients. In our previous study, we reported the effect of wetness and movement on the optical scanning time and accuracy using intraoral scanners. Since the cleft form and size vary greatly among CLP infants, we examined the effect of these factors on the scanning time and accuracy in this study.
Two resin casts of two unilateral CLP infants who visited the Orthodontic Clinic of Meikai University Hospital were used. The maximum alveolar length （31.0-32.0mm） and maximum alveolar width （45.0mm） were both comparable among the two cases, but the cleft form and size were quite different. Case 1 （30days old） was a right unilateral CLP infant with alveolar and palatal clefts of 2.0mm and 11.5mm, respectively. Case 2 （20days old） was a left unilateral CLP infant with alveolar and palatal clefts of 11.5mm and 18.0mm, respectively.
The optical scanning time was significantly longer in case 2 than in case 1 by 82％. The effect of wetness and movement on scanning time was larger in case 2 than in case 1. It was likely that the longer scanning time in case 2 was due to the larger surface area and the three-dimensional cleft form with undercuts. In our previous study, we reported that the application of a landmark between the alveolar cleft reduced the scanning time. In this study, the effect of two materials having different surface smoothness on reducing the scanning time was examined. As a result, the smoother surface material more effectively reduced the scanning time, without affecting the scanning accuracy.
The findings suggest that a larger cleft requires a longer optical scanning time. The application of the smooth surface material between the alveolar cleft is likely to reduce the scanning time significantly.

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It is known that there is a higher incidence of supernumerary teeth in cases with cleft lip and/or palate than others. However, the relation between the appearance of supernumerary teeth, and the cleft type, cleft side and the direction of tooth eruption is still unclear. Thus, we performed a clinicostatistical study by examining cleft lip and/or palate cases at Meikai University Hospital.
One hundred and three non-syndromic cleft lip and/or palate cases were used in this study. There were 48 males and 55 females （aged 4 to 29 years old at first visit）. In this study, cases in whom it was difficult to determine late remaining deciduous teeth and supernumerary teeth were excluded. X-rays （panoramic radiograph, dental X-ray, occlusal X-ray and cone beam X-ray）, dental casts, facial and oral pictures, and treatment records were examined. Four unilateral cleft lip, 21 unilateral cleft lip and alveolus, 40 unilateral cleft lip, alveolus and palate, 4 bilateral cleft lip and alveolus, 9 bilateral cleft lip, alveolus and palate, 19 cleft hard and soft palate, and 6 cleft soft palate cases were used. The following points were examined: 1） ratio of cases with supernumerary teeth, 2） ratio of supernumerary teeth for each cleft type, 3） ratio of maxillary supernumerary teeth in cleft and non-cleft sides, 4） position of supernumerary teeth, 5） relationship between the position of the cleft and supernumerary tooth, 6） direction of supernumerary tooth eruption.
Cases with more than one supernumerary tooth accounted for 19 out of the 103 cases （18.4%, male 20.8% and female 16.4%）. The ratio was the highest among cases with unilateral cleft lip （75.0%）, followed in order by unilateral cleft lip and alveolus, unilateral cleft lip, alveolus and palate, bilateral cleft lip, alveolus and palate, and cleft hard and soft palate （42.9%, 12.5%, 11.1%, and 5.3%, respectively）. Supernumerary teeth were most frequently seen adjacent to the maxillary lateral incisors （82.5%）. In unilateral cleft cases, 93.8% were seen in the cleft sides, suggesting a close relation between the supernumerary tooth and cleft lip and/or alveolus. The normal direction of supernumerary tooth eruption was seen in 88.9%. All these findings indicate that the appearance of supernumerary teeth has a close relationship with cleft formation.

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In recent years, the number of reports describing the use of augmented reality （AR） technology for various applications has been increasing. Additionally, while AR systems previously required high-level engineering systems, procedures using simple and inexpensive devices are now becoming available, and inexpensive and open source software applications have been developed to facilitate their use. In this paper, we report on a proposed AR-based technique that is built around a MOVERIO^Ⓡ see-through smart eye-wear device that has the potential to assist the treatment of unilateral cleft lip patients undergoing rhinoplasty surgery. In our study, in which two cases were examined, three-dimensional （3D） images were produced from patient data using a VECTRA H1^Ⓡ imaging device prior to surgery, and then superimposed on the patients’ faces using the MOVERIO^Ⓡ device during the corrective operations. During this process, two types of image of the patient’s nose were prepared. The first image type showed the patient’s face prior to the operation, while the other showed the corrections necessary to minimize the cleft lip and match the opposite side of the patient’s face as closely as possible. Since it is possible to switch these two images in the MOVERIO^Ⓡ device, as necessary, the surgeon can quickly reconfirm the degree of correction being made to the patient during the surgical procedure itself. Taken together, the study results show that our proposed method, which requires just a few special devices and no specialized software applications, has the potential to serve as a very useful tool for assisting doctors engaged in rhinoplasty surgery. Furthermore, even though there are a number of problems that remain to be resolved, such as differences between the image and the actual surface of the patient’s face, time lags, and tunnel vision produced by the device itself, further developments are expected to resolve these issues in the near future.

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An alveolar bone graft for patients with cleft lip and palate may cause nasopalatine duct cysts. This case report presents a nasopalatine duct cyst in a patient with a cleft lip and alveolus and discusses the etiology. The patient was a 43-year-old man with swelling of 10mm on the left anterior hard palate. He had a medical history of microform cleft lip for which lip plasty had been performed in his childhood followed by alveolar bone graft and correction of the lip and nose deformity at 31 years of age. CT examination revealed a penetration image which included the incisive canal and spread from the upper anterior incisor tooth cephalad to the area of the alveolar bone graft. Excisional biopsy was performed and a diagnosis of nasopalatine duct cyst was made. The possibility of injury and/or infection has been reported as an etiology of this cyst. However, it is hard to determine whether the procedure of lip plasty or correction of the lip and nose deformity could affect the maxilla. The surgical procedure of alveolar bone grafting or physical stimulation by a grafted bone itself against the incisive canal could be related to the development of a cyst.

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We report the 12-year follow-up results of a patient who underwent Millard type gingivoperiosteoplasty （GPP） following presurgical nasoalveolar molding （NAM）.
The patient was a female with left cleft of the lip and the palate, and the alveolar cleft width was 13mm on the first examination at 2 weeks after birth. NAM was initiated 3 weeks after birth. Cheiloplasty （triangular flap＋Millard method） including GPP was performed when the alveolar cleft became 1mm after about 4 months of NAM treatment. Palatoplasty （modified Furlow method） was performed at 1y2m.
On re-evaluation at 4y7m of age, the morphology of the lips and nose was symmetric and favorable, the profile was slightly concave, and an anterior crossbite was found with lingual inclination of the upper anterior dental alveolus. Based on X-ray radiography, the patient was diagnosed with skeletal classⅢ tendency, the lateral incisor on the cleft side was absent, and a bone bridge was present in the alveolar cleft region. The unnecessity of early secondary alveolar bone transplantation was confirmed, but active orthodontic treatment was necessary for crossbite correction, and the patient used maxillary protraction headgear for 4 months. At one year after the diagnosis, the occlusal conditions were favorable. Speech therapy was not necessary throughout the phase.
The lip and nose morphology and cleft site condition 12 years after GPP following NAM were very favorable, suggesting that this surgical procedure exhibits a positive effect on the facial esthetics and bone formation on the cleft site. Further investigation with regard to jaw development is necessary.

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