A clinical and statistical investigation was carried out on patients with cleft lip and/or cleft palate and other congenital anomalies at the Orthodontic Clinic in Fukuoka Dental College Medical and Dental Hospital over the past 17 years（2002-2019）. The following results were obtained: 　1．There were 119 cleft lip and/or palate patients and 49 patients with other congenital anomalies including 17 diseases. 　2．The distribution of cleft type was: cleft lip and palate 43.7％, cleft lip and alveolus 26.9％, cleft lip 11.8％, cleft soft palate 9.2％, cleft palate 5.9％, and submucosal cleft palate 2.5％. 　3．The distribution of other congenital anomalies was: 13 patients with Down syndrome, 11 patients with Goldenhar syndrome, and 1 to 4 patients with a variety of 15 other diseases. 　4．The number of both cleft lip and/or palate patients and patients with other congenital anomalies was found to be increased. The mean age of the patients at the first visit to the orthodontic clinic was 9.3years. 　5．A total of 74.8％ of cleft lip and/or palate patients and 59.2％ of patients with other congenital anomalies were referred from the Clinic of Plastic, Reconstructive, and Aesthetic Surgery of Fukuoka University Hospital, while 22.4％ of other congenital anomalies patients were referred from dental practitioners. 　6．Regarding the frequency of malocclusions in cleft lip and/or palate patients, 56.3％ had occlusal anomalies and 84.0％ had space anomalies. For the other congenital anomaly patients, 55.1％ had occlusal anomalies and 93.9％ had space anomalies. 　7．Type 1（no crossbite）was the most frequently-occurring crossbite classification for cleft lip and/or palate patients, at 56.3％.

View full abstract

Background: Children have a physiologically higher oxygen consumption at rest, lower functional residual capacity, and anatomically shorter neck compared to their larger head, smaller nostrils, larger tongue, and enlarged tonsils, which are considered to cause airway obstruction, respiratory depression, and hypoxia. In addition, the frequency of sedative cardiac arrest in children is said to be equivalent to that under general anesthesia, and sedation is known to have a high risk. On the other hand, the removal of unsettled thread is a burden not only on the patient and their family, but also on medical personnel, involving restraint and pain. 　Purpose: In our department, post-operative thread removal of cleft lip repair and secondary lip repair are performed under general anesthesia in the operating room. We review the details of general anesthesia under general planned hospitalization, and report the points of the procedure. 　Subjects/Methods: Primary cleft lip repair was performed in our department for 11 years from January 2008 to December 2018, and threads were removed under general anesthesia in 9 of 22 cases. We explained the procedure and performed the operation for those cases who agreed. 　The method of anesthesia, time of anesthesia, time of thread removal, and complications were retrospectively investigated based on medical records. 　Results: The anesthesia method was GOS （Gas, Oxygen, Sevoflurane: dinitrogen oxide, oxygen, sevoflurane） in all cases. The mean anesthesia time was 13 minutes 43 seconds, and the mean thread removal time was 6 minutes 27 seconds. There were no serious complications such as cardiac arrest, delayed awakening and respiratory problems. 　Discussion and Conclusion: Thread removal performed under the supervision of an anesthesiologist who is used to observing patients in a state of anesthesia and who is experienced in airway maintenance technology, ensures safety compared with suture removal under self-administered sedation. In addition, because the procedure ended on a predetermined date, it seemed to be effective in reducing the physical and psychological burden on patients and their families as well as medical workers.

View full abstract

The authors had an opportunity to observe clinical practice and receive instruction on clinical research at the Cleft Lip and Palate Center, the Center for Complex Craniofacial Disorders, the 22q Center, the Velopharyngeal Dysfunction Program, and the Speech Pathology Department at the Nationwide Children’s Hospital （NCH） in Columbus, Ohio, USA. 　The Plastic and Reconstructive Surgery Section mainly performed surgeries for craniofacial and oral-maxillofacial anomalies and speech assessment related to these conditions. These programs offered clinics which were not limited to only congenital anomalies such as cleft lip and palate, but also 22q11.2 deletion syndrome, velopharyngeal dysfunction and associated speech disorders. 　The multidisciplinary team for these clinics included plastic surgeons, otolaryngologists, oral maxillofacial surgeons, geneticists, orthodontists, psychologists, speech language pathologists, nurses, a team coordinator, and social workers. The team provided comprehensive care, including diagnosis and treatment planning, in those clinics. 　NCH provided lectures for the patients and families and family social events, and actively used SNS to promote and report on those events. 　In comparison with general clinical practice in the oral-maxillofacial field in Japan, the treatments for patients with CLP are divided into two specialized clinics, one makes evaluations and a treatment plan as a team, and the other provides daily speech therapy based on the treatment plan. All team members were treated based on a common understanding among multiple specialties. Multidisciplinary treatment is provided with a common understanding by the whole team. 　In addition, there are exclusive administrative staff at the clinic. This environment enables all staff to concentrate on their work. 　Based on the knowledge gained from these experiences, the authors re-acknowledged the importance of multidisciplinary collaboration.

View full abstract

The authors had an opportunity to observe clinical practice and receive instruction on clinical research at the Cleft Lip and Palate Center, the Center for Complex Craniofacial Disorders, the 22q Center, the Velopharyngeal Dysfunction Program, and the Speech Pathology Department at the Nationwide Childrenʼs Hospital （NCH） in Columbus, Ohio, USA. 　In the Speech Pathology Department, speech therapies were based on the diagnosis and assessment at the Cleft Lip and Palate Center. Speech therapy was usually recommended before palatoplasty performed around age six months and this early intervention targeted stimulating expressive language and preventing the development of articulation disorders. Regarding patients with symptoms of VPD, speech therapy addressed correct speech that could potentially result in leading to maximum VP closure. This was advised prior to surgical planning, in order to activate attempts at VP closure during the production of accurate oral speech sounds. NCH prioritized speech therapy to eliminate articulation errors. 　Regarding speech therapy at NCH, the treatment goal of “acquisition of age-appropriate intelligible speech” is the same as that of SLPs in Japan. The strategy for early intervention for VPD at NCH seemed different from those in Japan. 　Based on the knowledge gained from these experiences, the authors consider that the strategy of preventing the development of speech errors and early intervention could usefully be introduced in Japan. In addition, the authors re-acknowledged the importance of evidence-based speech therapy.

View full abstract

The incidence of twins with a cleft lip and/or palate is low. It is extremely rare for both dizygotic twins to have a cleft lip and/or palate. There are few reports of the long-term observation of dizygotic twins with differing cleft types. We have consistently treated dizygotic twins for cleft lip and/or palate that grew up in the same home environment until they were 18 years old. The twins were born at 36 weeks and 4 days of gestation and were females. The older twin had a complete right cleft lip and an alveolar ridge （UCLA） while the younger twin had a complete left cleft lip and palate （UCLP）. The younger twin was slightly underweight. Neither twin had any symptomatic disease. On the 27th day following birth, the parents brought them to our department to treat their UCLA and UCLP and improve their feeding. Both children underwent cheiloplasty （Cronin method＋Tange method） when they were 5 months old. The UCLP child underwent palatoplasty （pushback method） at 1 year and 6 months old. Orthodontic treatment was started at the age of 7 years and 2 months for both twins. Alveolar bone grafting with particulate marrow and cancellous iliac bone was performed at the age of 8 years and 11 months to induce the eruption of canine teeth into the dentition. Later, orthodontic treatment for permanent dentition was performed. At the age of 17 years and 11 months, rhinoplasty was performed at the request of both patients. There were some similarities and differences between the two children over the long-term observation period. During their treatment, it was necessary to solve the problems that occurred at each age, cooperating with the related departments and understanding the needs of the parents and children.

View full abstract