The craniofacial growth of complete unilateral cleft lip and palate patients, received orthodontic treatment was studied by means of lateral cephalometric roentgenograms.
The patients consisted of 24 males and 23 females ( Gr.1 ). The longitudinal cephalograms for each patient were obtained at the age of 8,11,14 and 16. The orthodontic treatment was started at the age of 8 and continued to the age of 16. The orthodontic management was almost identical for all patients. For the control, two different types of control groups were used. One is the group of UCLP, consisting of 96 males and 93 females without orthodontic treatment ( Gr.2 ). And the other is the group of 47 males and 36 females with no congenital deformity in the oro-facial region ( Gr.3 ). The surgical repair of lip and palate for the UCLP was performed at Department of Oral Surgery, Osaka University Dental School and the surgical procedures were almost identical for all patients.
The following results were obtained.
1) The characteristics of the craniofacial morphology in Gr.1 before treatment were the retrognathic maxilla, shortening of the upper face and backward rotation of the mandible. But by the orthodontic treatment, the antero-posterior dimension of the maxilla was significantly larger than that of Gr.2 and the anterior upper face height- also had the tendency to be longer than that of Gr.2. However, the growth of the maxilla of Gr.1 was still less than that of Gr.3.
2) According to the principal component anlysis, variance for the depth of the anterior cranial base, the maxilla and the mandible in Gr.1 came to relate positively from the age of 11.
3) According to the discriminant function analysis, craniofacial morphology of three groups were distinguished by the 2 discriminant function. The result obtained is as follows; Size of the maxillary depth was the biggest in Gr.3, followed by Gr.1 and Gr.2 (1st discriminant function }. The degree of backward rotation of the facial skeleton was the greatest in Gr.1 than Gr.2 and Gr.3 followed respectively (2nd discriminant function ).
4) According to this analysis, the patients in Gr.1 that had larger antero-posterior dimension of the maxilla, and posteriorly positioned gonial region at the age of 8, was found to attain the more satisfactory antero-posterior relationship between the maxilla and the mandible at the age of 16.

View full abstract

One hundred and three cleft palate patients submitted to palatoplastic operation around the age of 2 years were reviewed when they were 6 to 7 years-old and the speech results were compared with that obtained at the age of 4to 5 years.
Pres ent investigation revealed that 95 out of 103 patients (92.2% ) were of nomal speech with adequate velopharyngeal function compared with 94 normal speech patients (83.5 %) and 17 patients with some speech defects at the age of 4 to 5 years. This improvement was due to the fact that 10 of 17 abnormal speech patients, who already had adequate velopharyngeal closure at that time, abtained normal speech in these two years.
Rest of the patients (7 patients) who had had some speech defects and varying degree of incompetent velopharyngeal function also improved in some extent both in speech and in velopharyngeal function. However, some of these patients showed remarkable hypertrophy of the pharyngeal and/or palatal tonsils and these lymphatic organs seemed to be contributing to the improved function of the velopharyngeal sphincter.
It was also found that even in some normal speech patients, especially in patients with short palate but adequate velopharyngeal closure, remarkably hypertrophic tonsils seemed to aid successful closure of the velopharyngeal sphincter.
From these fin dings, further observation of the patients seemed to be necessary, at least until these lymphatic organs become atrophic.

View full abstract

The purpose of the present study was to clarify the mechanical contraction properties of the levator veli palatini muscle in dogs. Thirty dogs were used under intraperitoneal anesthesia with pentobarbital sodium. The levator. veli palatini muscle preserved with blood supply was developed from the surrounding structures through the access from the submandibular regin. The muscle was dissected at the mid-palate and the dissected end of the muscle bundle was ligated with thread vhich was connected to the isometric transducer. The levator veli palatini muscle was stimulated electrically with platium wire electrodes and the muscle contraction variables were recorded.
The result were summerized as f ollows:
1) The contraction time and the half relaxation time of maximal isometric twitch of the muscle were revealed to be 43msec. and 33msec., respectively.
2) A clear summation of muscle contraction was obtained with stimulation at 15Hz and maximal tetanic tension was at 70Hz. The tetanus twitch tension ratio was found to be 5.7.
3) The extension of the muscle prolonged the twich contraction times and the twitch half relaxation times. Besides, the amplitudes of the twitch and the tetanic contraction were closely affected by the change of the muscle length.
4) Both of the maximum twitch and tetanic amplitudes were obtained at the optimal length of the muscle (L_o: the length at the maximum twitch amplitude).
The tetanus twitch tension ratio was not cha n ged within the range of L_o±2mm.

View full abstract

The purpose of this study was to investigate the dental problems of the patients with cleft lip and palate before orthodontic treatment. The subjects selected for this study were six or seven years old and consisted of 142patients; 107 with unilateral cleft lip and palate (UCLP) and 35 with bilateral cleft lip and palate (BCLP).
The materials used in this study were dental casts and panoramic X-ray films obtained from the patients before treatment. The control group consisted of 50 patients aged six or seven with mandibular prognathism. The following findinfs were obtained.
1. The incidence of hypodontia of the permanent teeth was higher in the upper teeth than the lower teeth. Of all patients in the UCLP group, hypodontia was found in 27.1 % of the upper lateral incisor on the non-cleft side and 65.4 % on the cleft side, and 9.3% of the upper second bicuspid on the non-cleft side and 12.1% on the cleft side. Of all patients in the BCLP group, hypodontia was found in 65.7 % of the upper lateral incisor on the right side and 68.6 % on the left side, and 17.1 % of the upper second bicuspid.
2. In most cases of the BCLP group, buccal cusps of upper molar rotated mesially, and that of lower molar rotated distally.
3. The dent al caries of the upper and lower deciduous teeth was more prevalent in the cleft group than the control group.
4. In the U CLP group, the upper lateral incisor showed lingual displacement, rotation, and mesial or distal inclination, and the upper central incisor showed lingual displacement and rotation. In the BCLP group, the upper lateral incisor showed lingual displacement and the upper central incisor showed lingual or distolingual inclination. Rotation of the upper central incisor was found to be more severe on the left side than the right side;
5. Upper arch length, molar arch width, arch circumference and deciduous canine arch width in the cleft group were smaller significantly than those in the control group.
6. The cleft group showed severe negative overjet and smal ler overbite. A large number of the patients in the cleft group showed Class ji molar relationship and marked cross-bite at the area of the deciduous canine, t he deciduous second molar, and the first molar. Characteristics of occlusion in the UCLP group was the severe cross-bite at the deciduous canine area on the cleft side.

View full abstract

It is well known that most of cleft lip and cleft palate cases present narrower maxillary arches than non-cleft cases, in the lateral and/or antero-posterior dimensions. For these cases, many mechanical devices may be utilized for widening the palate. However, accompanying with the expansion of the arches, the postoperatively remanied oronasal fistulas were coincidentally widened together with the expansion of the maxillary segments.
In the present study, changes of the width of these oronasal fistulas were measured and the rat io of the expansion width before and after orthodontic treatment were compared using 16 cleft lip and cleft palate subjects.
Results obtained were as follows;
1. The oronasal fistulas were widen ed in all subjects under orthodontic lateral expansion treatment.
2. There was high coeffcient in the expanded ratio between the size of the oronasal fistula and the palate.
3. There was high coeffcient in the ratio between bone defect of the palate and oronasal fistula-expan sion.
4. The shapes of the all oronasal fistulas were varied resultant with maxillary lateral e xpansion.
5. The most oronasal fistulas were widened more lterally than antero-posteriorly, but in the cases of which the shape were similar to circle, they were widened more antero-posteriorly than laterally.

View full abstract

A child with syndromic occurence of multiple malformations such as bilateral cleft lip and palate, coloboma of the right iris, obstruction of the nasolacrimal duct, ring constriction, amputation and syndactyly of the limbs is presented in this report. Malformations of the limbs were diagnosed as congenital constriction band syndrome from these clinical features.

View full abstract

A eight-year-old boy consulted us about an anomaly in the soft palate. An oral examination showed bilateral symmetric fistulas of the soft palate. The patient had been asymptomatic concerning these fistulas. No other significant findings could be seen in the general condition. The form of these fistulous openings was oval, the diameter of which was about 3 mm, and their depth was approximately 15mm. In contraradiographic features, there was no communication with the palatine tonsillar fossa, and both fistulas seemed to lie along the anterior pillars of the isthmus fauces.
Several cases of bi lateral symmetric fistulas of the soft palate have been reported since the 19th century. Some authors have suggested that these fistulas may be associated with developmental anomalies(e. g., absence of one or both palatine tonsils, preauricular fistulas, and deafness).
According to these considerations, the bilateral fistulas above mentioned may be derived from the developmental abnormality of the second branchial pouch.

View full abstract

porcelain fused-to-metal crowns as abutments and removable partial dentures with precision attachments have often been applied.
But the in fluence of prostheses on pulp and marginal gingivae of abutment teeth should be minimized in any cases, particularly in adlolescent patients. For these reasons, fixed bridges with pins and ledges have been recomended for those young patients.
Since the 4 META adhes ive resin having the resin-to-teeth and resin-to-metal attachment mechanism introduced, the resin-bonded retainer have been able to use for those cases. The resin bonded retainer consists of two thin lingual metal plates and the pontic. It has several advantages comparing conventional fixed prosthodontic appliances, such as no pulpal and dential involvement, virtually no teeth preparation, supragingival margin, imporved esthetics, simplicity in fabrication and reversibility as Livaditis (1982) stated. From these facts, this method is considered to be particularly suitable for treating adolescent patients having cleft lip and alveolus.
In our study, this type of fixed bridge were applied for two patients and good results in apperarance and function were obtained.

View full abstract

In order to expand the collapsed upper dental arch of the patients with unilateral cleft lip and palate effectively, bilateral expansion or unilateral expansion as indicated by the case is definitely needed. The method of unilateral expansion of the upper dental arch of this type of patients, however, has not been introduced yet.
This paper dealt with an appliance which was newly designed for unilateral expansion.The efficiency of the appliance was first checked on a typodont and this type of design presented in this paper was found to be effective in expanding the arch unilaterally. The application of this appliance to four patients revealed satisfactory results. Although the lesser segment is generally easier to be expanded than the larger segment, it was even possible to expand the larger segment laterally by this appliance when necessary. The force system produced by this type of appliance was discussed.

View full abstract

The malocclusion caused by a cleft lip and palate involves so many complicated problems for oral rehabilitation. Therefore, the necessity of team approach to long-term planing of treatment has been emphasized.
A 19-year-old patient with a unilateral cleft lip and palate, and with the following oral features: underdeveloped maxilla, missing of teeth mainly in the upper segment and the unerupted upper right second molar, lisping in pronunciation, received orthodontic, surgical, and prosthodontic treatment on team approach.
The following procedures were done on the patients. Gingiva over unerupted tooth (7) was exicised to facilitate the eruption of 7. A removable expansion plate was installed to slowly expand upper arch. The expanded position has been maintained by using autogenous iliac bone graft. The lower arch was leveled off with edgewise appliance. Finally, as prosthodontic treatment, Dolder bars were made to connect the upper remaining teeth and a partial overdenture was inserted.
As a result, improvements of occlusion, facial c ontour, masticatory function and speech have been achieved and there have been no relapse over a period of 2 and a half years.

View full abstract

Orthognatic surgery is often applied for adult cleft lip and palate patients who can not to be treate d by ordinary orthodontic or prosthodontic treatments. In these cases, cooperation among orthodontists, dental surgeons and prosthodontists is especially needed.
In some cases, more than two times of surgical operation are necessary and it take a long time until the final prosthodontic treatment begins. So during that time, temporary prosthodontic appliances become necessary for the esthetic and functional reasons.
Such temporary appliances should be simple in structure and have enough retention and stability as well as be easy to maintain by patients.
In our study, a tempo rary denture was fabricated for a post-operative unilateral cleft lip and palate 19 years-old patient with the use of attachments (CM-Rider) utilizing the rapid expansion appliance. And good results in retention, stability, function and esthetics were obtained.

View full abstract

Three cases of orthodontic treatment for bilateral cleft lips and cleft palate patients were presented. Orthodontic treatment objectives were discussed together with the plans to be succeeded. The treatment objectives' and treatment plans by Showa University Method were established as follows:
1. Expansion of the collapsed arch.
2. Correctioning of the vertical deficiency in the canine area.
3. Repositioning of the floating premaxilla.
4. Growth control of the mandible.
5. Prevention of the relaps e.

View full abstract

This study was designed to learn what kinds of concers the mothers of cleft palate child had regarding cleft palate problems and how they were initially informed of their child's defect. We used a questionnaire to obtain these date. Sixty-eight mothers of children with cleft lip and/or palate were examined. The examinations were carried out, respectively, at the times of the initial investigation, lip repair, and palatoplasty.
The results were as follows:
1. Initial investigation
1) The mothers who had initially learned of the cleft while they were in the hospital included most of those in the cleft lip group and cleft lip and palate group, but only two-thirds of those in the cleft palate group.
2) In the majority of cases, the mothers were told of the cleft by their obstetrician.
3) Most of the explanations to the mothers involved “diagnosis” and “the availability of remedial surgery.” In the cases of cleft palate, the mothers were also told about “speech difficultie s. ”
2. Mothers' concerns were related to the nature of the defect and child development. The main concerns of the mothers were as follows:
1) At the time of lip repair in the cleft lip group: “hereditary implications, ” “psychosocial and child care problems” and “the having of more children-.”
2) At the time of initial investigation in the cleft lip and/or palate group: “postoperative ploblems: appearance and speech,” “psychosocial and child care problems” and “hereditary implications.”
3) At the time of lip repair and palatoplasty in the cleft lip and palate group: “postope rative problems: appearance and speech” and “hereditary implications.”
4) At the time of palatoplasty in the cleft p alate group: “postoperative problems: speech.”

View full abstract

Nine hundreds and ninty six cases of cleft-lips, cleft-lips with cleft-palates, cleft-palates, and facial clefts who visited to our clinic in the period 1981 April to 1982 March were analyzed.
1. There patients were occupied 24.5 percent of all our clinic's patients (4073 cases).
2 Proportion of affection was 37.3% in cleft-lips,46.9 % in cleft-lips with clef t-palates, and 14.8 % in cleft-palates.
3. 46.9 percent of the group were children from 0 to 5 years.
4. The refered patients were occupied 79.8 percent of th e group.
5. Proportion of the patients area was 69.1 % in Aich prefe cture,14.5% Gifu prefecture,8.8% in Mie prefecture. Thus, there were patients visited from all over the Chubu district in Japan.

View full abstract