To confirm the optimal bone grafting operation with autogenous particulate marrow and cancellous iliac bone, images from axial computed tomography （CT） were evaluated. Ten alveolar clefts from nine patients received grafted iliac bone in the Oral Surgery Department at Tohoku University Hospital between October 2011 and March 2015. Cleft type was unilateral cleft lip and alveolus in 2 cases, bilateral cleft lip and alveolus in 1 case, and unilateral cleft lip and palate in 6 cases. Mean age at the time of operation was 11.9 years. Mean width of the alveolar cleft was 7.6mm on the alveolar crest side and 16.0mm on the nasal floor side. Mean mass of transplanted iliac bone was 4.8g. CT scan was performed preoperatively and at 1 and 6 months postoperatively. Areas of the alveolar cleft, grafted bone and bone bridge were measured automatically by software using stored images at the height midway between the alveolar crest and nasal floor. Mean alveolar cleft area was 94.0mm². Mean grafted bone area at 1 month postoperatively was 138.4mm². Mean proportion of grafted bone area to alveolar cleft was 154.4％. Mean area of bone bridge at 6 months postoperatively was 100.2mm². Mean percentage of bone bridge area to the alveolar cleft was 109.9％. At 6 months postoperatively, the mean percentage of bone bridge area was 72.0％ of the bone grafting area at 1 month postoperatively. These findings suggest that when the alveolar cleft is to be grafted with autogenous iliac bone to form a sufficient bone bridge, loss of grafted bone must be considered.

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【Purpose】Recently, we began using presurgical nasoalveolar molding to reposition the premaxilla, and stretch the columella and nasal lining before surgery. We also started to perform the primary repair of bilateral clefts by the cutting method. We measured the shape of the nose for a few years after surgery, and compared the cutting method group with the conventional methods group.
【Subjects】The subjects were 24 patients （15 males and 9 females）. 10 patients were treated by the cutting method （cutting method group） and 14 patients by conventional methods （conventional methods group）.
【Methods】The surgical results were analyzed using photographic records obtained an average of 3 years after operation. Measurements of the nasal tip height, columella height, nasal width and nasolabial angle were obtained.
【Results】Nasal tip projection, columella length, nasal width and nasolabial angle were all significantly better in the cutting method group than the conventional methods group.
【Conclusion】The cutting method produced more satisfactory outcomes for bilateral cleft lip nose.

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We investigated nasopharyngeal function, hearing, language development, improvement of articulation, and type of complicated nasopharyngeal articulation in 39 cases of complicated nasal articulation in which patients with cleft lip and palate or hemifacial microsomia consulted the Department of Oral-Maxillofacial Surgery and Orthodontics, The University of Tokyo Hospital.
Velopharyngeal insufficiency was detected in 38％ of cases, and hearing impairment in 20％, with hemifacial microsomia present in three of those cases. There was a high probability of language development delay in all cases.
When nasopharyngeal articulation was not accompanied by other articulation disorders, or when velopharyngeal function was good, there was a tendency for improvement of nasopharyngeal articulation.
Cases of complicated nasopharyngeal articulation were mostly cases of glottal stop articulation.

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Infants have a cavity in their palate. The cavity is called sucking fossa and plays a significant role in grasping the nipple during sucking action. In many cleft lip and palate infants, a palatal plate is often used to help their feeding function. We conjectured that a palatal plate shaped sucking fossa activates their tongue movement during sucking action and facilitates effective sucking.
The aim of this study was to verify the effect of the palatal plate shaped sucking fossa （improved type） on the tongue movement of cleft lip and palate infants during sucking for the purpose of ensuring effective sucking. The subjects were eight cleft lip and palate infants with no disease influencing sucking function except the cleft lip and palate. The tongue movements of 8 cleft lip and palate infants during bottle feeding were recorded by an ultrasonic diagnostic apparatus under two conditions: with the existing type of palatal plate, and with the improved type of palatal plate. Eight specific points on the tongue were marked in each ultrasonic dynamic image （B-mode） of the tongue movements. Movements of those points were processed by DippMotionPro to draw the movements as waveforms.
The amount of displacement and period of movement were measured by 10 stable waveforms at each of the eight points for all subjects. The average displacement and period with the improved type were 24.7±2.3mm and 0.82 ±0.02s, while the averages with the existing type were 23.4±0.9mm and 0.78±0.04s, respectively. These results indicated that the tongue movement of cleft lip and palate infants was greater and more stable when using the improved type. This finding suggests that the palatal plate shaped sucking fossa induces effective sucking in cleft lip and palate infants.

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The purpose of this study was to survey the opportunity and determine the reasons why mothers explain the condition of cleft lip and/or palate to their children.
We conducted semi-structured interviews from December 2016 to May 2017. The participants were 13 mothers whose children （from first to third grade of elementary school） were hospitalized and affected with cleft lip and/or palate. The participants were asked about their opportunities and reasons for explaining the condition of cleft lip and/or palate to their children. Qualitative data were analyzed using the qualitative descriptive method. The average age of the participants was 39.5 （SD 3.9） years. The mean age and SD of their children （number of boys and girls were 6 and 7, respectively） were 8.2±0.8 years. The number of cases of cleft lip and alveolus, and cleft lip and palate, were 3 and 10, respectively.
The analysis resulted in 19 codes and 4 timings. 1） Timing upon entering elementary school; for example, the child’s condition might be pointed out by a friend at school. 2） Timing of having surgery; for example, a child’s father proposed informing the condition to his child frankly before surgery. 3） Timing of when the child becomes interested or concerned about his condition; for example, a child was asked about his injury by a friend in nursery school. The child could not answer well and asked his mother about it. 4） In daily life; the mother did not want to hide the condition and thought it was time to tell her child about it. Medical care providers should assess how parents explain the condition of cleft lip and/or palate to their children, and help reduce anxiety about such explanations.

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We report the case of a unilateral cleft lip, alveolar and palate patient who underwent occlusion reconstruction by distraction osteogenesis and dental implant placement for an insufficiently grafted alveolar cleft. A 22-year-old man presented requesting prosthetic treatment for loss of the upper-left incisor. To compensate for the insufficient diameter of the bone bridge, we performed alveolar bone distraction osteogenesis with extraction of the adjacent tooth before placing two implants. Vestibuloplasty using free gingival flap was performed 6 months after implant placement, and the final prosthesis was attached after correction of the gingival morphology by the provisional restoration. As a result, it was possible to perform functional and aesthetic prosthetic restoration.
In conclusion, in the case of dental implant treatment for insufficient diameter of the bone bridge, it is considered to be useful to perform bone augmentation by alveolar bone distraction osteogenesis.

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