Morphometric analysis using quantitative shape data plays an important role in the treatment of cleft lip and palate or assessment of the results. The data have hitherto been obtained by measuring the length and angles between anatomical points. However, such data contain less information than the actual shape information, and so the original images cannot be reconstructed from this data. Geometric morphometrics （GM） is a multivariate statistical analysis method based on the coordinates of anatomical landmarks or functions expressing outlines of the shapes, which evaluates the tendency of shape variations within a group or among several groups. This method has a tremendous advantage in preserving the morphological information through all procedures involved in the study, description of precise shape differences, and visualization of the results as informative graphics or animations. GM is a relatively new method that was developed in the 1980s and has now become prevalent mainly in biology and anthropology. This can be attributed to the development of computer technology and software that are easy to use. However, only a few morphometric studies using GM have been reported in the field of medicine as well as in studies on lip and palate. This article introduces the concept and application of GM and some software that are useful for GM analysis and then reviews previous research related to the use of GM in studying cleft lip and palate.

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Patients with cleft lip and palate experience various symptoms including esthetics, speech, occlusion and psychosocial aspects. Most of the conventional outcomes focused on esthetics and function and were based on clinicians’ point of view; not as much attention has been paid to psychosocial aspects, with a lack of patients’ point of view. CLEFT-Q is a cleft-specific questionnaire that measures patient-reported outcomes by 100-point scores. It covers all fields of symptoms experienced by cleft patients. It has been translated into multiple languages and designated as a part of the standard set of outcomes for cleft care. This study was conducted to generate a Japanese version of CLEFT-Q through translation and linguistic validation.
The process complied with guidelines to establish validity and reliability. Forward translation was conducted by two independent translators to generate two Japanese versions, from which reconciliation was conducted to generate a single Japanese version. This version was reverse-translated into English by another translator, and harmonization was conducted through discussions with the original authors to generate a tentative Japanese version. A pilot study on five cleft lip and palate patients was conducted, and further modifications were made based on the opinions from the patients and the authors to generate the final Japanese version of CLEFT-Q.
Introducing CLEFT-Q into clinical practice will improve the quality of cleft care through enforcement of conventional outcomes by adding patients’ point of view and evaluating psychosocial aspects. Consequently, more comprehensive and holistic care will be achieved. CLEFT-Q can be used to assist decision-making by patients themselves, or to evaluate the quality of care based on patients’ point of view. Further study to evaluate the validity and reliability of the Japanese version of CLEFT-Q is under way, to enable it to be used as a tool to provide scientific evidence.

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This study aimed to identify awareness about cleft lip and/or palate （CLP） in elementary school teachers, and to examine the difficulties they experience when working with such students. We conducted a cross-sectional study from September 2017 to January 2018 using self-administered anonymous questionnaires. The questionnaires and accompanying letters requesting participation were mailed to 6,000 elementary school teachers across 1,000 public elementary schools. Descriptive statistics were computed, and qualitative data were examined using the content analysis method suggested by Berelson. This study was approved by the ethics committee of our university. Responses were obtained from 412 teachers, of which 405 were used in the analysis after excluding incomplete or invalid responses. The average age of the teachers was 47.2 （SD＝8.9） years and the average number of years of experience was 23.3 （SD＝9.7） years. Participants correctly recognized that CLP was caused by complex interactions between co-occurring hereditary and environmental factors. Further, while they were aware that the prognosis of CLP was good, they regarded it as a disorder that caused problems related to appearance. With reference to concerns of students with CLP regarding school life, the teachers perceived that such students were concerned about their appearance, friendships, and pronunciation aspects. The difficulties experienced while teaching students with CLP were: Problems arising from unclear pronunciation; difficulties in responding to teasing/bullying; problems in the development of self-esteem; difficulties in explaining the disorder to other children; difficulties in responding to parents of students with CLP; need for consideration when swimming; need for mental-health follow-ups for students with CLP; difficulties in confirming the extent to which students with CLP understand their disorder; need for common understanding among faculty and staff; and being confused about CLP. These findings suggest the importance of shared understanding among parents and teachers regarding not only CLP-related educational needs, but also the status of children’s understanding of their disorder and measures to control teasing/bullying regarding CLP by other children.

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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 grandmothers’ psychological states related to the medical workers and their peers during the period from being notified 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 the medical workers into the following two categories: 1） anxiety and confusion caused by unacceptable information, and 2） relief and trust through appropriate interventions by the medical worker. In addition, the participants’ psychological states related to their peers consisted of the following category: 1） relief provided by their peers. Some of the participants received informed consent and followed the process of medical and nursing support, and thus correctly understood the disease, had trust in medical workers, and were provided with relief. We believe that true team medical care should include the family, including the grandmother.

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This study analyzed 183 patients with primary cleft lip and/or palate who visited our department during the 9-year period between 2011 and 2019. We evaluated the effect of the new activity of visiting a maternity hospital starting in 2014.
The results were as follows:
1．This study identified 183 primary cases of cleft lip and/or palate among patients attending our department.
2．Of the 183 patients, 82 had cleft lip and/or alveolus （44.8％）, 59 had cleft lip and palate （32.2％）, and 42 had cleft palate （23.0％）.
3．There were 92 male and 91 female patients, corresponding to a male to female ratio of 1.01：1.
4．The age of patients at first visit was recorded, and we found that 61 patients （33.3％） presented to our department within 7 days of birth.
5．The average birth weight of the patients was 2,978.4g. The birth weight of 71 patients, representing the largest proportion （39.4％）, ranged from 3,000g to 3,499g.
6．The average age of mothers at delivery was 31.5 years. The age at delivery of 49 mothers, representing the largest proportion （29.3％）, ranged from 30 years to 34 years.
7．A total of 22 patients （12.0％） had a congenital anomaly.
8．The total number of operations was 554 cases during the 9-year period from 2011 to 2019. The greatest number of operations was 130 cheiloplasties （22.3％）.
9．The total number of patients visiting in a maternity hospital was 45 cases, and this activity was able to reduce the mental burden on the patient’s family.

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Nasolabial cyst is a non-odontogenic developmental soft tissue cyst occurring in the periphery of the lip and nose, and is considered synonymous with nasal alveolar cyst according to the second edition of Histological Typing of Odontogenic Tumours by the WHO （1992）. Various theories have been proposed as to the etiology of this disease, including the retention cyst theory, the fissural cyst theory, and the embryonic nasolacrimal duct epithelial remnant theory, but none have been formulated. In the present study, we report a case of nasolabial cyst in the nasal vestibule of a patient who underwent a series of surgical procedures for unilateral complete cleft lip and alveolar, including labioplasty, secondary lip and nasal correction, and secondary bone grafting in the alveolar cleft.

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