The pharyngeal flap operation is considered to cause the morphological changes of the articulatory organs such as the changes of the shape and the size of the vocal cavity. The aritculatory organs were measured by means of cephalometric radiography at rest and during phonation of Japanese vowels before and after the superiorly based pharyngeal flap operations by Nagai's or modified Skoog's method.
1. The degree of the elevation of soft palate during phonation reduced after the operation, and the pre- and postoperative movements of the soft palate during phonation were significantly related.
2. The base of the pharyngeal flap at rest was positioned inferior to the palatal plane and to the level of the preoperative minimum velarpharyngeal constriction distance. It moved slightly upward and forward during phonation. And the velarpharyngeal flap moved apparently upward during phonation.
3.Generally, the posterior pharyngeal wall was located forwar d after the operation. During phonation the superior part of the posterior pharyngeal wall moved forward, and the middle and inferior parts of the posterior pharyngeal wall moved backward both pre- and post-operatively. The movement of the posterior pharyngeal wall during phonation slightly reduced after the operation. And the pre- and post-operative movements of the middle and inferior parts of the posterior pharyngeal wall were distinctly related.
4. After the operation the tongue moved forward, and the front part of the tongue was observed to move upward and the back part of the tongue was observed to move downward at rest. The highest point of the tongue relative to palatal plane moved to the anterior-superior direction and the posterior point of the tongue relatives to the pterygomaxillary plane moved to the posterior-inferior direction at rest. The tongue was observed to move the posterior-superior direction during phonation of the front vowels and the front part of the tongue was observed to move to the frontal-superior direction during phonation of the back vowels. The distance between the soft palate and the tongue shortened during phonation of all the vowels after the operation.
5. The hyoid bone moved to the posterior-inferior direction after the operation. The hyoid bone was observed to move to the posterior-inferior direction during phonation both pre- and post-operatively.
6. The base of the pharyngeal flap by modified Skoog's method was positioned superior to that by Nagai's method. During phonation the movement of the base, soft palate and the velarpharyngeal flap by modified Skoog's method was larger than that by Nagai's method. No remarkable difference was observed on the position and the movement of the posterior pharyngeal wall between these two methods.

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The sound changes before and after the pharyngeal flap op e ration were analized by sound spectrograph. The results were as follows:
1. On the first formant the bandwidth decreased on vowels except [i], and the frequency and the amplitude relative to the fundamental tone reduced on five vowels [a], [i], [u], [e] and [o] after the operation.
2. On the second formant the bandwidth and the amplitude relative to the fundamental tone decreased on vowels except [i], and the frequency decreased in front vowels [i] and [e], but increased in back vowels [a] and [o]after the operation.
3. On voiced plosives and affricates the duration of the preceding waves shortened and amplitude relative to the following vowel decreased after the operation.
4. The appearance rate of the consonant waves apparently increased, but that of the abnormal consonant waves decreased on consonants except nasals and flapped sounds after the operation.
5. After the operation the duration of the consonant part shortened on plosives and affricates, but apparently lengthened on voiceless fricatives. After the operation the amplitude of the consonant part relative to the following vowel tended to decrease on voiceless plosives and nasals, but tended to increase on voiceless fricatives, voiced plosives, affricates and flapped sounds.
6. After the operation the amplitude of the consonant waves relative to the following vowel increased on all the consonants except nasals and flapped sounds. The frequency of the peak amplitude of the consonant waves apparently increased on fricatives and affricates.
7. After the operation the appearance rate of the aspiration obviously increased on voiceless plosives and the appearance rate of the voice bar in low frequency region on the transitional part decreased on voiceless consonants. The amplitude of the aspiration relative to the consonant wave and the amplitude of the transitional part relative to the consonant part tended to reduce.
8. After the operation the freq uency locus of the second formant decreased on almost all consonants, and the duration of the transitional part of the first formant tended to lengthen on voiced plosives and flapped sounds.
9. There was no evident difference in sound changes before and after the operation between Nagai's and modified Skoog's method.

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108 facial plaster models with unilateral clefts of the lip were examined morphologically, and 10 normal infants were as control group.
The results w ere as followings.
(1) The deformities of the face under the influence. of cleft lip and cleft palate were those of 1) the cleft width of the lip 2) the width of the nose 3) the width between both sides of the nasal alar base 4) the dis t a n c e between the nasal apex and the lateral nasal alar point on the cleft side 5) the nostril width on th e cleft side 6) the sideward deviation of the nasal apex 7) the sideward deviation of the base of columella 8) t h e sideward deviation of the nasal base on the non-cleft side 9) the sideward, downward, backward deviatio n of the nasal alar base on the cleft side 10) the sideward, upward, backward deviation of the cup i d 's bow peak on the cleft side.
(2) The deformities o f the face, especially under the influence of the cleft lip were those of 1) the sideward deviation of the mid-point of the cupid's bow 2) the sideward, downward, backward deviation o f the lateral nasal alar point on the cleft side 3) the sideward, forward deviation of the cupid's bow peak o n the non-cleft side 4) the sideward, upward, forward deviation of the peak of the cupid's bow on the media l side (the future cupid's bow peak on the cleft side).
(3) The deformities of the face, especially under the influence of the cleft palate were those of 1) the distance between the internal eye angles 2) the width of the nose 3) the distance between the nasal apex a n d the lateral nasal alar point on the cleft side 4) the nostril width on the cleft side 5) the sideward deviation o f the lateral nasal alar point on the non-cleft side. cleft lip, especially on the complete type.
(5) According to the three-dimentional comaprisons of the face, the most greatest deviation, especially under the influence of the cleft lip and the cleft palate, was the lateral deviation, and next was the antero-posterior deviation, and the vertical deviation was the least of all.
(6) The morphological difference between the cleft side and the non-cle ft side of the unilateral cleft lip was great due to the cleft width of the lip and the cleft palate. And the difference was more remarkable by t h e rotation of the premaxilla of the cleft lip that resulted in a important factor to perceive the deformities o f the face.

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In order to obtain successful velopharyngeal competence as well as to minimize deficiency in the development of the maxilla, the method employed in palate surgery dependent upon each patient with this objective in mind. Morphological studies of the velopharyngeal orifice area were carried out in 20 patients with the method and results being as follows.
1) Silicone rubber impressions for plaster models of the nasopharynx were taken from the maxilla of each patient before surgery, under GOF anesthesia with endotracheal intubation. Morphological analysis of the velopharyngeal orifice area in cleft children were performed employing these plaster models.
2) From the models, it was feasible to observe repeatedly, the details of the nasopharynx, the palatal circumstances and the dental arch.
3) These velopharyngeal orifice areas varied with each patient. Their morphological types and sizes did not always correspond to each cleft pattern.
4) In general, velopharyngeal orifice sizes in cleft lip and palate children were larger than those in isolated cleft palate children.
5) It is suggested that these morphological studies on the preoperative velopharyngeal orifice may provide effective data for palate surgery as well as the investigations of the pattern of the cleft, and the mobility of the oropharyngeal muscles.

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Velopharyngeal orifice areas in 80 cases of cleft palate children were examined by the same method as indicated in the previous report for the purpose of elucidating their morphological characteristics.
1) Velopharnygeal distance, cleft width, lateral width and the size of the velopharyngeal orifice in the CLP children were relatively larger than those in CP children. Above all, velopharyngeal distance and cleft width of CLP were significantly influenced at the 5 per cent level.
2) In CP and CLP groups, the following correlation coefficiencies were found to exist; between velopharyngeal distance and velopharyngeal orifice size (0,7638,0.8237), lateral width of the velopharyngeal orifice and the size (0.7414,0.3724), cleft width and the size (0.3903,0.0191), lateral width of the velopharyngeal orifice and cleft width (0.5904,0.2044).
3) Velopharyngeal orifice was classified into the following four types. Type 1 (normal type); Patients with this morphlogical type had relatively shorter velopharyngeal distances and lateral widths of the velopharyngeal orifice area, and the sizes of the orifice were within 100 mm2. In these cases, satisfactory velopharyngeal competency was obtainable by means of minor surgery such as by von Langenbeck palate plasty. Type 2 (longitudinal type)and Type 3 (crosswise type); The velopharyngeal orifice size ranged between 100 mm2 150 mm2. In these types, minimizing of the orifice and prevention of maxillary ankylosis were possib le by means of modified Widmaier palate plasty. Type 4 (severe type); This type had larger velopharyngeal orifice sizes than the other three types. Orifice sizes were over 150 mm2.
In order to obtain the development of satisfactory speech in this type, V-Y advancement such as Wardill operation was advised.

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Cleft lip is always accompanied with an asymmetry of the nose, as is very often called "cleft lip nose". Accordingly, correction of the asymmetry of the nose is an important objective of the cleft lip operation. In order to obtain a good result of symmetry of the nose, an exact estimation of a possible symmetry of the nose should be necessary prior to operation. However, the estimation of a probable symmetry of nose has been largely depended on the subjectivity of examinors.
In the prese n t study, we attempted to numerize the state of symmetry of the nose by using a moire topography which provides a simple, one-step method for mapping the contour of the subject on a single photograph. Thus, a front view of the face of the subject was photographed with a moire camera, Fujinon FM 3012. The photograph was then printed on a paper one half the size of the face. Moire strives were subsequently processed by a coordinate measuring equipment "Gradicon", and the obtained values were applied on the following equations to obtain such four indexes calculated by a microcomputer, "Wang 2200".
Symmetry index
Total symmetry index
Revised symmetry index
Total revised symmetry index
Twenty six normal individuals were first examined in this way and the above four indices were calculated as controls.
Twenty cleft lip nose patients were next subjected to the evaluation for above four indices and at the same time these patients were also evaluated subjectively by 33 examinors for symmetry of the nose.
Calculations of the regression line and correlation coefficient clearly demonstrate d that the symmetry indices, thus obtained from the cleft lip nose patients, agreed well with the subjective evaluations by examinors.
These symmetry indices may be also useful for the examination of the symmetry on the other part of the body such as the face, back etc.

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The effect of a dynamic palatograph is studied in speech therapy of the five pos t operative cleft palate patients with the palatalized articulation. They are three males and two females, ranging from 5 to 19 years old and their velopharyngeal closure were good.
The results were as follow s:
1) These subjects obtained normal speech by this method from three months to fourteen months.
2) The dynamic palatograph could reveal a distinctive tongue-palate contact of the palatalized articulation. So the patients could understand their faulty articulations clearly, and correct them.
3) The period of speech therapy was not shorter than that which did not use the dynamic palatograph.
4) Speech therapy of the cleft palate patients by the dynamic palatograph gave us consideration to check the shape of the palate and the dintition, and to teach the patients how to control air flow in articulation.

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Palatolingual contact of the 20 cleft palate subjects judged to have defective articulation after palatoplasty (11 subjects having sufficient velopharyngeal closure after early operation and 9 other subjects) were observed by the dynamic palatography which was an electric device capable of recording constantly changing palatolingual contacts as a function of time by means of artificial palate equipped with numerous electrodes. The palatogram patterns obtained were classified to establish more objectiveproceduresto evaluate articulation and toput it to clinical use.
The items of classifications are as follows:
1. Continuity of contacts: open type (S and O), closed type (T and Max).
2. Position of contacts: frontal type, backward type (b).
3. Area of contacts: peripheral (1), broad (2).
4. Symmetry of contacts: symmetric, asymmetric (').
5. Position of opening: medial, lateral (").
The palatogram pattern at the time of maximum contact and production of Japanese consonants [s, dz, ts, f, d, tf, t, d, n, r] which were produced by the contact of the tongue with the alveolus or the hard palate wer e devided into 4 groups and 20 subgroups combining these items.
As the chracteristic patterns different from the normal, t he following types were observed: 1) Sb, Sb', Tb, Tb'type in which the position of contacts were deviated to the backward,2) Max type in which whole palate were closed with the tongue, and 3) O type in which palatolingual contact were not recognized.
The manner of articulation represented with the changes of the patterns fro m the time of the maximum contact to the production of consonants were devided into following 4 groups: 1) Release maintaining manner (S or O to S or O),2) Closure to release manner (S or O to T or Max),3) Closure maintaining manner (T or Max to T or Max), and 4) Untouched manner (O to O).

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