Many studies have been performed on the static facial appearance after cleft lip surgery in patients with unilateral lip and cleft palate （ULCP）, and morphological improvements in the soft and hard tissue have been demonstrated. However, the movement of soft tissues during smiling remains unclear. Therefore, we investigated the three-dimensional movement of the lips and cheeks during smiling in patients with ULCP after cheiloplasty.
The subjects were 14 boys with ULCP （mean age 5.3 years） who consulted the Department of Orthodontics at Matsumoto Dental University Hospital. The subjects’ three-dimensional lip and cheek movements during smiling were analyzed using stereo images, and their frontal craniofacial morphology was assessed using posterior-anterior cephalograms. The relationship between the frontal facial morphology and the lip and cheek movements during smiling were analyzed.
The affected side of the angulus oris moved significantly outward, upward, and rearward compared with the non-affected side. The downward movement of the central part of the lower lip was significantly larger than the upward movement of the central part of the upper lip. On the other hand, there was no significant difference in the movement of the cheek between the affected and non-affected sides.
Regarding the relationship between the movement of the lips and cheeks and the frontal facial morphology, the differences in mandibular width between the affected and non-affected sides, and the amount of menton deviation were significantly positively correlated with the difference of the horizontal movement of the angulus oris between the affected and non-affected sides. The differences in maxillary and mandibular height between the affected and non-affected sides were significantly negatively correlated with the difference of the vertical movement of the angulus oris between the affected and non-affected sides.
This suggested that the angulus oris on the affected side moved more upward, outward, and rearward than the non-affected side during smiling, resulting in an asymmetric smile in patients with UCLP. An asymmetric smile is related to the frontal facial morphology.

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The purpose of this study was to clarify the differences and related factors between self-evaluation and parents’ evaluation of the QOL of children with cleft lip and/or palate （CLP）. We conducted and analyzed a questionnaire survey of 133 pairs of CLP children and their parents by using the Japanese version of KINDL^R. The results showed that self-evaluation and parents’ evaluation were positively correlated with the total score and all sub-region scores. The total QOL score was lower in the self-evaluation than in the parents’ evaluation, but there was no statistically significant difference. Similarly, among the sub-regions, “physical well-being” and “self-esteem” had a significantly lower self-evaluation, while “family” had a significantly higher self-evaluation. In particular, there was a significant difference in “self-esteem,” with a lower self-evaluation in comparison with factors related to gender （girls）, school type （elementary and junior high school students）, and cleft type （cleft lip and cleft lip and palate）. The low “self-esteem” of CLP children compared to parental evaluation is most concerning. Although CLP children and their parents are often involved with medical staff during operation and regular visits, it is suggested that medical staff should always try to talk to and respond to children in a way that makes them feel confident.

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In order to evaluate cleft lip and/or palate （CLP） patients visiting Meikai University Hospital, a clinicostatistical study was performed from January 2001 to December 2020.
1．The number of CLP cases was 284 （5.2%） of all cases who underwent orthodontic treatment. The number of CLP cases increased by 20.2% from the first decade to the last decade.
2．The most common age at the first visit was 0 years old （110 cases, 38.7%）, followed by 5 years old （26 cases, 9.2%）, 6 years old （23 cases, 8.1%）, and 4 years old （22 cases, 7.7%）. There was a dramatic increase in the number of 0-year-old infants at the first visit from the first decade （17 cases） to the last decade （93 cases）.
3．Of the 284 cases, unilateral CLP, cleft palate （CP）, unilateral cleft lip and alveolus （CLA）, bilateral CLP, bilateral CLA, and cleft lip accounted for 39.4%, 19.4%, 17.6%, 17.2%, 3.2%, and 3.2%, respectively.
4．There was a 2.1-fold higher ratio of males than females in CP cases. However, there was no gender difference in other types of clefts.
5．Hospitals affiliated to Saitama Medical University were the largest referring hospitals （63.6% and 53.6% in the first and last decades, respectively）. 70.5% and 82.6% of cases were referred by clinics of plastic surgery in the first and last decades, respectively.
6．After deciduous dentition was attained, there was an increase in cases without crossbite from 28.9% in the first decade to 53.8% in the last decade, even without active orthodontic treatment. In contrast, in the case of bilateral CLP, this value decreased from 15.4% in the first decade to 12.5% in the last decade.
7．Presurgical infant orthopedics were performed in 13.2% of all cases in the first decade, dramatically increasing to 50.3% in the last decade. 83.3% of cases who underwent presurgical infant orthopedics prior to 2015 returned to our clinic.
These findings indicate the role of our clinic was changed by improving surgical outcomes in cheiloplasty and palatoplasty and the occlusal condition before orthodontic treatment.

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Trisomy 18 and trisomy 13 are chromosomal abnormalities associated with various pediatric surgical disorders as well as severe psychomotor retardation and frequent characteristic physical abnormalities. Previously, conservative treatments were chosen for these abnormalities because of their extremely poor prognosis. However, in recent years, their natural history has been reviewed and the number of facilities providing aggressive treatment, including surgery, has increased. As a result, reports of long-term survivors have also increased. In this case report, we describe two cases of lip repair surgery on a 2-year-old male with trisomy 13 and a 5-year-old female with trisomy 18. They had previously undergone aggressive treatments for comorbidities. After lip repair surgery, their appearances were improved and their families are satisfied with the results. Furthermore, the quality of life（QOL）of both patients was enhanced. The severity varies from case to case, and ethical and social issues are involved in various situations such as diagnosis, treatment and post-discharge care. However, there is still an ongoing debate about treatment protocol. With the progress of medical treatments, it is expected that plastic surgery treatments in long-term survivors will continue to improve in the future. When deciding on the treatment option for plastic surgery, it is important to evaluate the general condition of the patient and fully confirm the intentions of the family before commencing treatment.

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