Cleft lip and/or palate patients treated in our department during the seven-year period from January 2010 to December 2017 were analyzed statistically.
1） We studied 313 patients who visited the Plastic & Cosmetic Surgery Department of Kawasaki Medical School Hospital which included 234 with cleft lip and palate and 79 with isolated cleft palate.
2） Regarding districts of residence, 75％ were from Chugoku and 17.4％ were from Shikoku. Thus, most of the patients were residents of the Chugoku and Shikoku districts.
3） Regarding age at first visit, 57.8％ were less than one month old and 81.7％ were less than three months old.
4） The average birth weight of the cleft lip and palate group was 3,005.9g and that of the cleft palate group was 2,911.7g.
5） The left-right ratio of the cleft side in unilateral cleft cases was 1.4 : 1 with left side predominance.
6） Cleft lip and/or palate patients were mostly males while isolated cleft palate patients were mostly females.
7） Consanguineous marriage was found in 11.7％ of patients. The incidence of cleft palate was three times higher in the cleft lip group than the non-cleft lip group.
8） Concomitant malformation was found in 15.8％ of all patients. Patients with isolated cleft palate showed the highest incidence of a variety of anomalies.

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Cleft lip and/or palate is a craniofacial anomaly, and the parents of infant patients with cleft lip and/or palate must make decisions on the treatment of their children. As the patients grow older, the decision-making process tends to transition from a parent-centered to a patient-centered process. However, making this change tends to be a difficult process. This study clarified parents’ decision-making about their adolescent children’s surgery to correct cleft lip and/or palate.
The study’s participants were 12 parents （one male; 11 females） who were caring for adolescent patients admitted to a hospital for cleft lip repair. The participants’ ages ranged from 40 to 60 years old. The adolescent patients’ ages ranged between 15 and 18 years old （six males; six females）. Data were collected in face-to-face semi-structured interviews and qualitatively analyzed using inductive content analysis.
There were three core categories: ［parents’ emotional reactions］, ［their children’s emotions］, and ［parent-child relationship］. When the adolescent patients made the decision to undergo surgery, the parents had ［parents’ emotional reactions］ about the cleft lip and/or palate condition, the surgery, and the adolescent. The parents tried to understand ［their children’s emotions］ from the children’s perspectives, and the parents aligned their emotions to those of their children by empathizing so that they and their children could undergo the surgery in the ［parent-child relationship］. There were seven categories of ［parents’ emotional reactions］, such as “postoperative anxiety” and “confusion about the child’s true feelings.” Four categories of ［their children’s emotions］ were extracted from the data, such as “their children’s postoperative anxiety.” Regarding the ［parent-child relationship］, there were five categories, such as “adjustment of the parents’ intention to that of their child” and “taking on the role of spokesperson for their child.”
This study’s results suggested that parents caring for adolescent patients adjusted their personal emotions and their children’s emotions through their relationships with them so that the parents and their children could undergo the surgery and gradually transition to a patient-centered decision-making process regarding surgery. However, healthcare staff should provide additional support to help reduce parents’ sense of anxiety because this study’s parents reported personal postoperative anxiety and their children’s postoperative anxiety. Parents experienced an adjustment of the intentions to undergo surgery between them and their children and they took on the role of spokesperson for their children. However, parents stated that they felt confused about their children’s true feelings about the surgery. Healthcare staff need to determine whether intentions to undergo surgery are sufficiently considered by parents and their children.

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The purpose of this study was to survey the psychological state of grandmothers who have grandchildren with a cleft lip and/or palate between notification and post-cheiloplasty.
We conducted semi-structured interviews with the grandmothers after cheiloplasty at hospital A. The participants were 15 grandmothers （either paternal or maternal）. Qualitative data were analyzed using the qualitative descriptive method.
We classified the psychological states related to their grandchildren into the following six categories: 1） shock upon being notified of the grandchild’s disease, 2） suffering regarding the grandchild’s disease, 3） worries about the future of the grandchild, 4） relief by recognizing the grandchild’s disease, 5） readiness and determination for positive acceptance, and 6） happiness brought by the grandchild.
Some grandmothers had been shocked by visible differences, incorrect understanding of and prejudice toward the child’s disease, and had accepted the situation with positive thinking that “it cannot be helped”. Other grandmothers felt attachment and happiness, giving meaning to the fact that the grandchild had been born with a disease. The feeling regarding playing a role as a grandmother was raised, and the grandmothers felt that they could support their daughter and grandchild.
Medical workers need to understand these characteristics of grandmothers and their roles and to recognize the grandmothers as recipients of medical care.

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The aim of this study was to clarify the short-term effect of presurgical nasoalveolar molding （PNAM） treatment on the nasal morphology in patients with unilateral cleft lip and palate （UCLP）. In the study, we successively investigated the nasal morphology from the beginning of PNAM application to 6 months after cheiloplasty.
The subjects were 17 UCLP patients who had been treated at the Orthodontic Clinic, Niigata University Medical and Dental Hospital. The subjects were divided into two groups: the PNAM group （12 patients, 6 males and 6 females）, and the non-PNAM group （5 patients, 2 males and 3 females）. For morphological evaluation of nasal shape, the frontal and worm’s-eye view facial photographs, which had been taken at the first material taking （T1）, immediately before the cheiloplasty （T2） and after the cheiloplasty （T3）, were used. Six angular measurements were determined, and then the average values of those measurements at T1, T2 and T3, and the amount of change of T1-T2 and T2-T3, were compared between the two groups.
At T1, no significant difference was found in all items between the PNAM and non-PNAM groups. At T2, the PNAM group showed significantly smaller values of nasal tip angle and columella inclination angle compared with the non-PNAM group. The angle of the upper margin nostril on the affected side in the PNAM group was larger than that in the non-PNAM group. At T3, only the alar base inclination angle on the frontal view was smaller in the PNAM group than that in the non-PNAM group.
As for the changes of T1-T2 and T2-T3 in the PNAM group, some items showed significant changes both in T1-T2 and T2-T3. In contrast, significant changes were observed only in T2-T3 in the non-PNAM group. These findings suggested that PNAM treatment in our institution improved the deviation of the alar base before cheiloplasty. However, positive effects on the external nasal morphology were not found postoperatively in this study. Further studies are needed to discuss the effect of PNAM treatment.

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The bifid nose is an uncommon malformation with a wide range of clinical findings. Some authors have discussed the best time for surgery, the best surgical technique classified by severity, and the typical course of treatment, but their findings have still not been widely accepted. Because the severity of malformation can vary, it is an important key point in determining the appropriate surgical technique for reconstruction. In this report, we describe three cases that demonstrated mild, moderate and severe bifid noses and a new severity classification, with discussion of some of the literature.
Three children: a 13-year-old boy, a 6-month-old boy, and a 1-month-old girl presented with mild, moderate, and severe nasal bifidity. There were no associated craniofacial anomalies. Our assessment of the bifid noses in this series was used to establish a classification system, with the three cases classified as mild, moderate and severe. Mild cases present aberrant soft tissue and few abnormalities of the nasal cartilage, such as separation. Moderate cases present severe abnormalities of the nasal cartilage, including complete absence. Severe cases present aberrant nasal bones and severe saddle nose. In all three cases, we made a dorsal nasal skin excision to obtain a good surgical field. In all cases, the nasal cartilage was exposed and replaced under direct vision. In the mild case, bilateral separated nasal cartilages were moved medially by suturing them to each other and a dermal graft was put on the cartilages. In the moderate case, the upper lateral cartilage was found to be absent. The bilateral separated alar cartilages were moved medially by suturing each cartilage and the nasal fascia, and a dermal fat graft was added. In the severe case, a dermal fat and bone graft was inserted to modify the saddle nose.
This report describes only three cases, and thus it is important to investigate further cases in the future.

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