The purpose of this study was to clarify the relationship between preoperative posterior cleft width and postoperative speech outcomes among patients with unilateral cleft lip and palate. The subjects were 29 patients with unilateral cleft lip and palate who visited the Department of Oral-Maxillofacial Surgery and Orthodontics at the University of Tokyo Hospital between 2004 and 2014. Relationships between preoperative posterior cleft width and postoperative speech function （articulation and velopharyngeal closure function） were examined.
Cleft width was measured on maxillary alveolar models before palatoplasty using sliding calipers. Mean preoperative posterior cleft width was 10mm （median, 9.9mm）. The patients were divided into two groups according to cleft width: a ＜10-mm group and a ≥10-mm group. Palatal articulation was found in patients with 6mm, 8mm, 10mm, 11mm and 13mm cleft widths, and appeared regardless of cleft width. Glottal stop articulation was found in patients with 12mm, 13mm and 16mm cleft width, showing a significant difference between groups. Nasopharyngeal closure function was good in 92％ and insufficient in 8％ of the ＜10-mm group, compared to good in 75％ and insufficient in 25％ of the ≥10-mm group. These results indicated that wide clefts tended to produce nasopharyngeal insufficiency and glottal stop articulation. These results indicate that preoperative cleft width is relevant to postoperative speech function in patients with unilateral cleft lip and palate, and that preoperative cleft width is one predictor of postoperative speech function.

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After orthodontic treatment in patients with cleft lip and palate, a space is sometimes left in the dentition. For closure of this space, the use of a fixed retainer with artificial teeth has been preferred in recent times in our hospital. This study examined the use of this appliance in our hospital. The subjects included 308 patients with cleft lip and palate who underwent active orthodontic treatment from 1993 to 2019. Records, including oral photographs, radiographs, and dental models, were used for the clinical examination. We retrospectively investigated the records for the following: cleft type, observation period, existence of residual dental space and application of fixed retainer with artificial teeth at the start of retention, change of appliance to and from fixed retainer with artificial teeth, the site and number of artificial teeth, lingual wire fixation range, simultaneous use of removable retainer, breakdown （functional survival rate by Kaplan-Meier method）, and occurrence of dental caries. Cleft types of the 308 patients were as follows: 72 unilateral cleft lip and alveolus, 9 bilateral cleft lip and alveolus, 142 unilateral cleft lip and palate, and 85 bilateral cleft lip and palate. The mean observation period was 4 years and 1 month. At the alveolar cleft site, residual space was observed in 65 patients （21.1％） and this appliance was placed in 23 patients （35.4％）. During the retention period, the appliance was changed from the removable retainer with artificial teeth to this appliance in five patients, resulting in this appliance being used in 28 patients （43.1％）. This appliance was changed to prosthetic appliances in three patients. The artificial teeth were aligned at the position of the lateral incisors in 17 patients （60.7％） and the central incisors in 9 patients （32.1％）. Three to 8 teeth were used to fix the appliance. Twenty-six of 28 patients （92.9％） used the removable retainer simultaneously. The functional survival rate was 72.2％ at 13 years and 6 months. Five patients （17.9％） had dental caries. This appliance is useful for the retention of anterior teeth without shaving of the adjacent teeth and can be used for the long term, like an adhesive bridge. Appropriate maintenance with a regular follow-up of four to six months was considered necessary for long-term use.

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The purpose of this study was to survey the psychological state of grandmothers whose grandchildren underwent cheiloplasty to correct a cleft lip and/or palate （CLP）. Specifically, we clarified the grandmother’s psychological aspects related to her daughter and family in the period from being informed about the grandchild’s CLP through the post-cheiloplasty.
We conducted semi-structured interviews with each grandmother at the hospital after their grandchild’s cheiloplasty procedure. The participants were 15 grandmothers （either paternal or maternal）. Qualitative data were analyzed using the qualitative descriptive method.
Based on our analysis, we classified the participants’ psychological states related to their daughters and families into the following four categories: 1） concerns regarding their daughter’s suffering and the negative impacts on families, 2） determination to support their daughters, 3） relief that their daughters and families responded calmly and happily, and 4） relief by feeling the power of families in coping well with the circumstances.
Some grandmothers became more concerned about the physical and mental condition of their daughter than about their grandchild, particularly if their daughter was very upset about her child’s CLP.
The study clarified that when their daughters were in a critical situation, the grandmothers prioritized support for their daughters. Their distress lessened as they interacted with their daughters, facilitating their acceptance of their grandchildren’s CLP. In addition, grandmothers played a role in coordination and consideration, and were relieved to feel the power of their families.

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Trisomy 13 is a chromosomal disorder with systemic malformations reported by Patau in 1960. The prognosis is markedly poor, and 90％ of affected infants do not survive beyond the first year of life. Treatment strategies for patients with chromosomal abnormalities, such as trisomy 13, vary among facilities, and no consensus has been reached. We describe the case of a patient with trisomy 13 and bilateral cleft lip and palate who underwent cheiloplasty and required postoperative treatment for pneumonia. A 2-year-old girl underwent cheiloplasty using a modified Manchester’s technique under general anesthesia. She had already received a tracheostomy at the age of 1 year and 2 months, and so the intraoperative respiratory management was performed through the tracheostomy tube. The operation was completed without large fluctuation in her general condition and postoperative management was performed in the ICU. However, on the third postoperative day, she developed severe pneumonia. In cooperation with pediatricians, ventilator management and carbapenem antibiotics and immunoglobulin preparations were administered, her general condition improved, and she was discharged on the 14th postoperative day. At 1 year and 6 months since the cheiloplasty, her general condition is relatively stable and the surgical scar is not conspicuous.

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The postoperative stability of the inferior movement of the maxilla is poor after orthognathic surgery. This case report describes the orthognathic treatment of a unilateral cleft lip palate patient with severely retruded maxilla and crossbite. The maxillary segment was moved downward after Le Fort Ⅰ osteotomy and fixed rigidly with mesh-type plates.
The patient was a 21-year and 4-month-old female with left unilateral cleft lip palate who presented to Meikai University Hospital. Her chief complaint was anterior crossbite and nasal deformity. She had a short face and concave profile due to the underdeveloped maxilla. SNA and ANB were 66.5 and －10.5 degrees, respectively, showing a skeletal Class Ⅲ intermaxillary relationship. An unclosed alveolar cleft was seen on the left.
Secondary bone graft was performed at 22 years and 4 months old. After presurgical orthodontics, the maxilla was moved inferiorly （5.0mm） and anteriorly （5.0mm and 2.0mm on the left and right, respectively） by Le Fort Ⅰ osteotomy. To obtain rigid fixation between maxillary segments having spaces, titanium mesh-type plates were placed. Satisfactory postoperative stability was obtained up to 1 year and 9 months after the surgery. Finally, she underwent nasal reconstruction by transplantation of auricular cartilage and nasolabial flap at 25 years and 9 months old, and showed the anteriorly moved nasal tip and correction of nasal deformity.

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Prosthodontic treatment of cleft lip and palate patients has included conventional fixed partial prostheses and removable partial dentures for restoration of alveolar defects and missing teeth. It is desirable to check and adjust the prosthesis in order to adapt to changes in oral tissue and aging. We report the long-term observation of two clinical cases with regard to the application of magnetic attachments to the definitive prosthesis.
Case 1: The patient was a 36-year-old female with the chief complaint of esthetic problems caused by a bridge falling off （fixed partial denture）. The treatment design was a removable partial denture with magnetic attachment. Five teeth from the left canine to the right second premolar were included as abutments. The pontic was designed to be removable from the base portion of the bridge, and they are connected with a magnetic attachment. This case was followed for 19 years.
Case 2: The patient was a 21-year-old female with the main complaints of esthetic problems. The prosthesis design was a removable partial denture with magnetic attachment. The right maxillary first premolars, the left maxillary canine tooth and the first premolars were included as abutments. The right maxillary lateral incisor, central incisor, and left maxillary central incisor were connected with a magnetic attachment. The patient was followed for 27 years.
We have experienced these two cases of treating cleft palate patients with magnetic attachments, with long-term observation. Magnetic attachments have excellent features, but there are also points to be considered such as the amount of sacrificed tooth and hygiene. It should be possible to extend the longevity and achieve excellent clinical results by minimizing denture mobility, and performing regular maintenance, occlusal examination and adjustment.

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