The roentgencephalograms of 278 infants with unoperated cleft lip and/or palate were analyzed to see if the cleft types differ. These cleft types consisted of 36 incomplete unilateral cleft lip,46 incomplete unilateral cleft lip and alveolus,41 complete unilateral cleft lip and alveolus,11 incomplete bilateral cleft lip and alveolus,21incomplete unilateral cleft lip, alveolus and palate,84 complete unilateral cleft lip, alveolus and palate,12incomplete bilateral cleft lip, alveolus and palate, and 27 complete bilateral cleft lip, alveolus and palate.
Angular and linear measurements from the lateral and P-A X-ray headfilms, height, weight, and age were used to evaluate the craniofacial morphology by multivariate analysis. The results were as follows:
1. The data were subjected to a stepwise discriminant function analysis using the original thirty-three variables. Thirteen variables were selected as the best discriminators. In those variables, the length of the cranium (S-N, N-Ba) and the height of maxilla (Or⊥SN, Or⊥AnsPns) correlated reasonably well with the general body size.
2. Orbital, nasal and maxillary arch breadths from the P-A X-ray headfilms were wider in CLAP group than in CLA group. In CLA group, nasal and maxillary arch breadths of the cleft lip and alveolus were broader tha n in incomplete unilateral cleft lip.
3. There was a deficiency in maxillary forward growth in CLAP group without complete bilateral cleft lip, alveolus and palate.
4. The downward growth of the posterior limit of the maxillary base was inhibited in CLAP group compared to the CLA group.
5. The long axis of the upper deciduous incisor with sella-nasioh line inclined lingually in the clefts of the cleft lip, alveolus and/or palate compared to incomplete unilateral cleft lip.
6. The comparsion of craniofacial morphology in different cleft types indicated that the great similariry in general facial shape was found among the incomplete unilateral, complete unilateral and incomplete bilatera l cleft lip, alveolus and palate

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Twenty-five facial plaster models of three or four-month-old unoperated infants with bilateral cleft lip and palate (complete, incomplete, and mixed bilateral cleft lip) were measured in respect to several key-points of the lip, nose and eye. The contral sample of ten models was chosen by random selection from the normal infants with the same age as the cleft cases. The results were as follows.
(1) The distance b etween the entokanthion was longer in the bilateral cleft lip than the normal (hypertelorism).
(2) T he sideward deviation of the measured points of the bilateral cleft lip was remarkable, especially the transversal width, but the symmetry of the both sides of the face was good. The deviation of the nose tip, columella base, and mid-point of the cupid's bow were very small expect for the mixed bilateral cleft lip which was the same morphology as the unilateral cleft lip.
(3) The deviation of the bilateral cleft lip from the normal in term s of the vertical length of the measured points was little.
(4) The antero- p osterior deviation of the columella base and the mid-point of the cupid's bow of the bilateral cleft lip were very prominent due to the protrusion of the premaxilla.
(5) The height (anter-posterior direction) of the nose tip of the bilater al cleft lip was not different from the normal, but always gave the impression of saddle nose. It might be suggested that the forward displacement of the columella base, mid-point of the cupid's bow, and cheek made the nose relatively low in appearance.

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Validity of Computerized Tomography(CT) in evaluation o f velopharyngeal closure was examined. CT of the velopharynx in 5 normal subjects and 5 cleft palates were taken both at rest and during phonation /a/ or /i/. To obtain CT during phonation, CT apparatus with the scanning time of 4.5 seconds was used. It was revealed that the mobility of velopharyngeal closure, which is composed by elevation of the soft palate, inward movement of the lateral pharyngeal walls, and protrusion of the retropharynx, was clearly visualized in a single roentgenogram. Through the use of this rather simple CT technique, rational choice of treatment for cleft palates with velopharyngeal insufficiency seemed possible.

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Preanesthetic evaluation was estimated on the total 1,135 cases of 890 children with cleft lip and palate Rider 6 years old who were hospitalized in the Dental Hospital of Tokyo Medical and Dental Universit y for 5 years from 1976 to 1980. The evaluation was examined and compared with 50 children without cleft lip and palate of the same age during the same period in the hospital.
The body weight and height of the children with cle ft lip and palate estimated in aperiod from 1956 to 1964 were below thestandard value. But the latest ones were almost within the normal ranges.
The values of blood tests of both groups were not far from the normal ranges. The valuesof GOT, GPT, LDH and Al--P in the serum showed. a slightly high level, but there was no evidence of the hepaticdisturban ce.
Associated birth defects were seen in 7.1%of the children with cleft lip and palate; m i crognathiain 3.8 %and congenital heart disease in 1.5 % among them.
From the view point of their physical co ndition, the anesthetic and/orsurgicalrisk was not so poor. It is important that the anesthesia should carefully be given to the children with cleft lipandpalate, as they often have complications of malformation and upper airway inflammation.

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Median cleft of the lower lip and mandible is extremely rare. In our cou ntry, only nine cases have been reported so far in the literature. In this paper we present a three-month-old girl with a median cleft of the lower lip and mandible. Neither family history nor associated malformations of other portions of the patient was noted. At the age of four months reconstruction of the cleft lip with z-plasty and of the ankyloglossia was performed. But no surgical intervention was made on the cleft of mandibular bone. The reasons why the surgery of the mandibular cleft is better postponed until her second decade of age is also discussed.

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The aim of palatoplasty is to gain both normal speech and normal growth of the maxilla, although these two are often uncompromised. We thought that atraumatic surgery would contribute to both of the aims, so microsurgical technique was applied to two types of palatoplasties.
Type I(F-I palatoplasty): Hinge flaps were elevated from the mucoperiosteum along the cleft margin of the hard palate under the operating microscope, and a full-thickness Z-plasty was carried out at the posterior third of the soft palate. This method is unapplicable to wide cleft cases, and ready to make a fistula at the hard palate.
Type II(F-II palatoplasty): A standard push back procedure was based upon. Under the operating micros c ope, the nasal raw surface was covered with two myomucosal flaps elevated along the margin of the soft palatal cleft. This method is easy to perform, never loose any tissue and can elongate the soft palate approximately one cm in length by these two myomucosal flaps themselves. These flaps will avoid scar contracture and maintain the effect of push-back and muscle sling.
Muscle sling was made in both types of palatoplasty. Each 8 cases had these two procedures. One year postoperatively, speech result of two procedures were compaired. Three out of 8 cases(38%) which had F-I palatop lasty were troubled with fistula formation or velopharyngeal imcompitence. All cases which had F-II palatoplasty revealed a good speech except for one(88%), in which a wide bilateral alveolar cleft was left open. Speech of this particular case was fair by prosthetic application and expected to be good by continuing the present speech therapy resume.
Therefore, F-II palatoplasty is thought to be far better than F-I palatoplasty from the standpoint of speech evaluation one year postoperative.

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During past six years ten months,132 patients with cleft palate wearing speech aid to correct volopharyngeal incompetence were analyzed clinico statistically.
1. One hundred twenty five cases had been remained postoperatively velopharyngeal incompetency, but seven cases, submucous cleft palate all of them, were worn speech aid before operation.
2. Morphologically they were classified into four groups, that is, they were 22 cases with bilateral cleft lip and palate,62 with unilateral,40 with cleft palate and eight submucous cleft palate.
3. The age at wearing speech aid ranged from two years eight months to 53 years four months. Sixty percent of them were worn speech aid aged from two to six years.
4. One hundred twenty three cases had been operated at the other hospital and only two cases were operated in our clinic.
5. Primary palatoplasty was undergone in 51 cases (40.8%) aged one year and in 74 cases (59.2%) aged from one to two years.
6. The number of operation times before wearing speech aid was once in 103 cases (82.4%).
7. Presently, seventy cases were concluded speech therapy and seven cases acquired good speech without speech therapy after wearing speech aid.
8. Fourteen cases (10.6%) were able to remove speech aid after they corrected speech disorder. The age of wearing speech aid ranged from two years eight months to 11 years old, and average length of wearing time was two years three months, ranging from eight months to five years.
9. Seven cases could remove speech aid after following surgical procedures: push back operation (three cases), velopharyngeal sphincteroplasty (two cases), folded pharyngeal flap (two cases).

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