It is indispensable for postoperative velopharyngeal closure to obtain full palatal length in primary cleft palate surgery. Pushback operations with VY designs of 3-flaps or 4-flaps have been widely practiced. But in the patients with alveolar cleft, the poor material in anterior part causes high incidence of oro-nasal fistula.
The method to cover anterior cleft with an incisive flap was reported. A long triangular mucoperiosteal flap whose base lies just palatal side of the upper 'deciduour incisions A⊥A and apex 5 mm caudal to incisive foramen is prepared and elevated. Incisive artery is elongated by severing the attendant connective tissue. The flap with vascular handle is mobilized and shifted onto the suture line of nasal layer in anterior region and fixed with mattress suture. The method reported provides complete palatal closure as well as sufficient pushback for patients with unilateral complete cleft.

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To reveal the entity of the lateral articulation which is a type of the misarticulation pronounced flowing out the air stream from the retromolar region to the angle of the mouth through the buccal groove,260 sounds diagnosed as the lateral articulation and 33 sounds suspected as it in 7 cleft palate patients who have sufficient velopharyngeal function after early operation were analysed by confusion matrix paradigm for phonemic feature and by dynamic palatography and cephalometric radiography with contrast medium attached to the tongue and palate for the tongue movement.
The results obtained were as fo llows.
1. The lateral articulation were observed in the Japanese CV or CSV syllables containing vowel [i.e], semivowel [j], consonants [s, ts, dz] and [ke, ge].
2. The manner of the tongue movement was the “closure maintaining manner” inwhich the tongue was contacted to the hard palate continuously during pronunciation.
3. The duration obtaining the “closed type” o f palatogram were from the production of consonants to vowels in the syllables followed by vowel /i/, from the production of consonants to the transition for the syllables followed by semivowel /j/, and during the production of consonants for syllables preceeded b y the consonants /s/ /t/ /z/. But, it was varialble for syllables /se, ze, ke, ge/.
4. The “Max” type in which whole palate were closed with the tongue were most frequently observed at the time of maximum contact and “Tb2”, “T2” were next in order of numbers. 5. By the phonemic analysis, dental, alveolar and palatoalveo l ar sounds were transcribed as sounds in which the place of articulation were more backwards than the sounds intended. [t∫, d₃] and [k, g ] or [∫]and [C] were confused each other.
From these results it is concluded that the lateral articulation of Japanese CV or CSV sounds were produced mainly as the disorders of the vowel /i/ /e/, semivowel /j/ and consonants /s/ /t/ /z/ du e to the broad contact of the tongue and hard palate during pronunciation.

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To have a grasp of the changes in lip pressure of cleft lip patients after cleft lip repair, is considered very important in predicting future jaw growth and the form of the dental arch.
The author previously reported on the chronological changes in the lip pressure at rest, the teeth, and the periodontal tissues in rhesus monkeys after an experimental labioplasty of the upper lip.
In the current study, the chronological changes in the lip pressure at mastication w ere examined using the same subjects ( 7 adult monkeys) and the- correlation between the lip pressure at rest and at mastication was studied. Th e results were as follows:
1) After the experime ntal labioplasty of the upper lip, the upper lip pressure at mastication increased remarkably but decreased gradually thereafter, and approximated the pre-operative pressure on the 30th day after operation.
2 ) The lower lip pressure, on the other hand, decreased slightly after operation. This decrease was due to a relaxing of the lower lip brought about by the labiOplasty of the upper lip. Thorelaxing was confirmed macroscopically. The pressure on the 15th day after operation approximated the pre-operative pressure.
3 ) The aforerentioned lip pressure at mastication showed a similar trend to that at rest as previously reported. However, the pressure at mastication was higher.
In view of the foregoing, cleft lip repair is consi dered to have some growth-restraining effect on the jaws and the form of dental arch in the early post-operative period. However, the repair is considered n ot to effect them after a certain period, as previously reported.
It was found that labioplasty of the upper lip will result in relaxation of the lower lip and cause shorttime regression to the pre-operative condition.

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In addition to the irregularities of the tooth size, shape or number which are of frequent occurence in cleft palate, the severe displacement or the abnormal inclination and the rotation of tooth is found around the cleft area.
This study was undertaken in order to determine the incidence of irregularities of the central incisor, lateral incisor and canine in cleft lip and alveolus with or without cleft palate cases, and also to attempt to establish a proper orthodontic management for the abnormal teeth.
A total of 145 cases with Hellman's dental stage III A ∼ IV A was studied. This sample included 19 unilateral cleft lip cases,4 bilateral cleft lip cases,98 unilateral cleft lip and palate cases, and 24 bilateral cleft lip and palate cases. Patient records were obtained from the file of the Department of Orthodontics,, Tokyo Medical and Dental University.
The central incisor exhibited the high incidence of the abnormal dental axis, such as lingual tip, tip toward the cleft and rotation, and only 2.1% normalcy in the unilateral cleft lip and palate cases. The lateral incisor exhibited the high incidence of missing or hypoplastic variations, and 27.8% normalcy in the unilateral cleft lip cases.
The canine exhibited the abnormal dental axis, such as toward the cleft and rotation, but higher incidence of normalcy than the central incisor and the lateral incisor. The management of these abnormal teeth were as follows; extraction or leaving as it was were limited to 8 cases, orthodontic tooth movement have been attempted on the rest of cases (137 cases) keeping the tooth materials to gain the rigid support for prosthetics.
We concluded that the management of abn ormal teeth must be considered as a part of oral habilitation, the extraction of the teeth closest to a cleft leads to the disadvantage for the prosthodontic treatment.

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Congenital dimple of the upper lip is a rare type of congenital malformation and interesting in relation to the development of the midface.
Recently we experienced three of such cases,
Case 1. Two year old female had a dimple in the midline of philtrum.
Case 2. Seven month old male had a midine dimple and median cleft of the upper lip, associated with convergent strabismus, asymmetry of nostriles, double frenum and ankyloglossia.
Case 3. Ten month old female had two dimples in a symmetrical fashion in the central part of the upper lip just below each philtrum rige and midline cleft of the upper lip with thick frenum.
Two cases of 3 were associated with median cleft of the upper lip, so it is reasonable to presume that the dimple has a close association with the facial cleft.
Simple excision of the dimple with vertical elliptical shape gave a satisfactory result.

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It is a severe shock for a mother to learn that her baby is physically defective. Her anxiety and confusion should be handled as early as possible. At their first visit to our hospital, Orientation Class was presented to the mothers in order to provide them with more information about the rehabilitaion program and to promote their co-operation in the program. The Class has been considered to be very effective for the purpose, but more detailed or quantitative assessment of our Class was felt essential for further improvement of our total care system. A series of questionare were filled out by 100 mothers who were the participants with their children aged from 2 to 4 years, in our rehabilitation program. An analysis of their responses revealed that:
a ) Most of the mothers reported that they had a little knowledge about some aspects of clefts, such as the word of “harelip” and the friend with repaired lip, previously the time before she had the baby.
b ) It was a severe shock for the mothers when they met their baby for the first time, then the y thought of death of baby or themselves and that of both.
c ) The Orientation Class played a great role for mothers' better understanding of the etiology of clefts, total care system, and for the relief of general impact of clefts.
d ) During the participation in the longitudinal rehabilitati on program with their children, most of the mothers could realize the rationale for the cleft management. However, those mothers had less th a n adequate information still now and the need for more delicate counseling procedures to provide d etailed informations for future management of their problem was indicated from the results.

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