It has been reported a little on swallowing pattern in patients with cleft lip and palate. In this study, tongue contact pattern, cheek pressure and orofacial muscle activity during swallowing were recorded at three periods: before and after lateral expansion of the maxillary dental arch and postretention. Experimental group included seven complete unilateral cleft lip and palate patients with anterior and posterior cross-bite (4 ? 7 years of age). Control group included two non-cleft patients with anterior and posterior cross-bite and two children with normal occlusion (the same age). Lateral expansion to correct posterior cross-bite was carried out by a removable plate with an expansion screw at a rate of 0.2mm/3 days. Tongue contact patterns with upper and lower dental arches, palate, etc. during swallowing were observed utilizing electropalatography (Rion Co. ). Electropalatography (EPG)recorded continuously tongue contact patterns with dental arches of artificial plate (EPG plate) with 56 gold electrodes at every 31.25 msec (32 frames/sec). At three periods of before and after expansion and postretention, tongue contact patterns at rest and during 2 ml water swallowing, in addition, cheek pressure and oro-facial muscle activity during 2 ml water swallowing were analyzed by following methods. (1) EPG was recorded by 15 electrodes in lower and 30-41 electrodes in upper plate with a screw embedded. (2) Cheek pressure against upper first deciduous molar area was detected by a small sensor. (3) EMG was recorded by bipolar surface electrodes from right temporal, buccinator on both sides, orbicularis oris and mentalis. EPG and cheek pressure, and cheek pressure and EMG were recorded simultaneously. The results obtained from this study were as follows: (1) At rest, cleft palate patients had low tongue position before expansion, but tongue moved upward after expansion and stabilized itself furthermore to approach to normal tongue contact patterns. (2) During 2 ml water swallowing, cleft palate patients swallowed with tongue contact to all area of upper arch at no or a little time before expansion. They swallowed with tongue contact long time on all area of upper arch after expansion, and swallowed smoothly with tongue contact to all area of upper and lower arches to get similar to normal swallowing pattern at postretention. (3) In normal children and non-cleft patients with cross-bite at postretention, the appearance of cheek pressure was agreed in time with the start of tongue movement during swallowing. But in most of cleft palate patients, they did not synchronize even at postretention. (4) During swallowing, cleft palate patients had not so greater cheek pressure before expansion than the normal. (5) In all cases, the maximal mean voltage amplitude of temporal muscle was the smallest in five muscles. The amplitude of buccinator muscles was greater in all the patients at postretention than that of the normal. In conclusion, by utilizing electropalatography, swallowing pattern became possible to be analyzed three-dimensionally, visually and with time.

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Preoperative features of the palate of cleft lip and/or palate infants and the effect of lip repair operation on the maxillary growth were studied using maxillary arch casts taken from 32 unilateral cleft lip (and alveolus) subjects (UCL),22 complete unilateral cleft lip and palate subjects (UCLP), and 7 complete bilateral cleft lip and palate subjects (BCLP).
Serial casts were taken from each patient at 2 months of age, immediately before and 1,3,6,9,12,18months after lip repair operation, and the longitudinal growth patterns of the three groups (UCL, UCLP, and BCLP) were evaluated by following provisions: (1) alveolar arch width and length by linear measurement, (2) tissue amount of the palate by highly accurate surface area measurements, (3)palatal figure in three dimensions by linear and angular measurements of transverse section figure. As a normal group, casts taken from normal children were obtained and analyzed as well.
Preoperative arch width was significantly greater in UCLP and BCLP than in UCL and the normal group, suggesting that cleft segments were displaced laterally by the pulling forces of the muscles around the palate and the pushing forces of the tongue. Alveolar arch length was the shortest in UCLP among the cleft groups and it was suggested that UCLP has an intrinsic retardation of the palatal growth. Palatal surface area had the tendency to decrease in the following order; UCL, UCLP, BCLP. In BCLP, transverse palatal length was shorter than that of other types. Therefore, its surface area seemed to be deficient in the medial border of the lateral segments which would otherwise be connected to the vomer. Tissue amount and other palatal dimensions in UCL was greater than those of the normal group, and accordingly, cleft lip seemed to bring about excessive growth of the anterior part of the palate owing to less lip pressure against the palate. Study of the transverse section figure revealed that both UCLP and BCLP have deep palatal vaults and their palatal shelves were much steeper than those of UCL and the normal group. The angle of the palatal shelves was the greatest in lesser segment of UCLP, followed by lateral segments of BCLP and then by greater segment of UCLP. UCL and the normal group had the smallest angles. Greater angles of the shelves in the cleft segments were seemed to be largely affected by upward pressure of the tongue.
Postoperative approximation of each segment was exerted by the medial rotation of the segments around the tuberosities in occlusal plane, also resulting in the decrease of the anterior part of the alveolar arch width. Alveolar arch length was also decreased by the retrusion of the premaxilla in BCLP and by the flattening of the anterior part of the greater segment in UCLP. The angle of palatal shelves of UCL and the normal group remained unchanged. In contrast, UCLP and BCLP showed continuous decrease over the entire period of observation time, except for a slight increase at one month after the operation. This increase in the angle suggests the vertical medial rotation of both segments around the upper part of the maxilla, which would partially contribute to the approximation of the two segments. Surface area of the palate in UCLP and BCLP also diminished one month after the surgery, but it was thought to be the loss of measurable surface area of medioposterior portion of the segments due to the medial rotation in occlusal plane.
Although growth inhibition of the maxilla was noticed in all cleft groups over the period of 9 to 12 months after the operation, the growth rate became almost normal in all groups thereafter.

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This study was designed to elucidate morphological characteristics of the upper dental arch and palate of cleft lip and/or palate patients after repair on lip and palate (push back operation). In particular, the extent of surgical influence was examined from maxillary plaster cast of each patient based on three-dimensional analysis by computer. The sample consisted of 33 cases of uni-lateral cleft lip and alveolus (CL),30 cases of cleft palate alone (ICP),40 cases of cleft lip, alveolus and palate (UCLP) and 25 cases of bilateral cleft lip, alveo-lus and palate (BCLP) ranging in age from 7 to 19years.
A narrowing and shortening of the dental arch were seen in each type of cleft. This is especially true in cases with UCLP and BCLP. The palatal volume and area of cleft palate group were significantly decreased compared to those of the control group, with the exception of the CL group. Furthermore, growth of the palate each age group increased as much as control in CP, less than control in UCLP and not seen in BCLP.
The shape of th e dental arch and palate was classified into the following five types by standardized data.
1) Type I had a good dental arch shape, within the length and width of the palate being within normal limits (CL: 100%, ICP: 40.1%, UCLP: 12.5%, BCLP: 8.0%)
2) Type II had a narrow dental arch at the level of the 1st molar or the maxillary tuberosity but the length of the palate was within normal limits (ICP: 30.3%, UCLP: 25.5%, BCLP20.0%).
3) Type IIIA had a shortened dental arch and wide opening of the maxillary tuberosity (ICP: 6.6%, UCLP25.5%).
4) Type MB had a resemblance to Type HIA, but did not show a wide opening of the maxillary tuberosity (ICP: 20.0%, UCLP: 22.5%, BCLP: 32.0%).
5) Type IV had a remarkably shorter and narrower dental arch than the other four types (ICP: 3.3%, UCLP: 15.9%, BCLP: 40.0 %).
In these five types, with advanc ing seriousness, reduction of the palatal depth is observed according as palatal area decreases. Reduction of these palatal depth after palatal surgery had close relationship to the amount of the scar tissue. Therefore, the surgeon must bear in mind to minimize the amount of palatal scar tissue as much as possible.

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Millard emphasized that the vertical lip height from alar base to Cupid's bow peak on the cleft side should be equal to that on the non-cleft side. We measured the distances of the cleft area using 100 facial plaster casts of preoperative unilateral cleft lip patients.
The following results were obtained.
1. The mean distance A-P (the vertical lip height s from alar base to Cupid's bow peak on the non-cleft side)is 11.4 mm on the incomplete cleft lip patients and 12.0 mm on the complete cleft lip patients.
The mean distance P-W (the distance from mouth angle to Cupid's bow peak on the no n-cleft side) is 17.9mm on the incomplete cleft lip patients and 15.5 mm on the complete cleft lip patients.
2. The mean distance A'-P' (the vertical lip height from alar base to the corresponding point of the Cupid's bow peak on the cleft side) is 8.6 mm on the incomplete cleft lip patients and 7.5 mm on the complete cleft lip patients.
The mean distance A'-P" (the vertical lip height from alar base to the point P" which is located distally by 1 mm from P' on the P'-W' line) is 9.2 mm on the incomplete cleft lip patients and 8.2 mm on the complet e cleft lip patients.
The mean difference of the distance A'-P' and A'-P" is 0.6 mm on the incomplete cleft lip patients and 0.7 mm on the complete cleft lip patients.
3. We could say that the increase of vertical lip height on the cleft side is about 2 mm when the point P' is moved distally by about 1 mm and when the tissue on the inferior part of the base of the alar is incorporated into the advancement flap.
In 36 cases out of 50 ca s es of the incomplete cleft lip patients and in 49 out of 50 cases of the complete cleft lip patients the difference between A-P and A'-P' was more than 2 mm.
The small triangular flap above the mucocutaneous border would b e required in addition to the rotation advancement method (Millard's method) for these cases.

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The present study was attempted to establish a p roper orthodontic management for isolated cleft palate patients. The dento-skeletal morphological analyses were taken with 41 cases selected from the files of Orthodontic Clinic of Tokyo Medical and Dental University.
As the result of investigation, high incidence of rotation, m alposition and congenital missing on lateral incisors were worthy of attention. Anterior and/or posterior cross bite was observed in most cases. Shallow palate, crowding and skewed upper arch were recognized in almost half of the cases.
Compared with non-cleft data, the patients with isolated cleft palate showed the follo w ing cephalometric characteristics; retruded maxilla, lingual tipping of upper incisors, tendency of reduced mandibular length, less growth increment of the maxilla and increasing tendency of backward positioning of the mandible to the cranial base with growth.
Orthodontic treatment for these cases, used in th i s study had been carried out mainly with the anterior and lateral expansion of the upper arch and growth control of the mandible. However, according to the result of this study, it is satisfactory to consider that the forward traction of maxilla or Le Fort I orthognathic surgery should be intended to apply for these patients.

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A 32-year-old female patient with unilateral cleft lip and palate had her lip repaired at the 3rd month after birth without subsequent closure of the palate was presented. From the findings of the cephalometric analysis and measurement of dental casts, undergrowth of the maxilla and contraction of the maxillary dental arch length was not observed. Position of the mandible was in normal range. It was suggested that the maxiillary growth was not restrained by the repaired lip and the maxilla was well developed owing to the persistent cleft palate.

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A 26-year old female with unoperated complete unilateral cleft lip and palate was reported.
1. Occlusion: No cross-bite was observed in both the anterior and buccal segments.
2. Craniofacial morphology: Analysis of the lateral roentogenographic cephalograms revealed that the length of the anterior cranial base was in the normal range, the maxilla was loca t e d anteriorly relative to the anterior cranial base and the maxillary depth was larger than th e noncleft subjects, although its vertical growth was less. Form and position of the mandible were in the category of the non-cleft subjects. These findings suggest that restricted growth, especially in the anteroposterior direction, of both jaws observed in the operated UCLP patients w a s caused by the plastic surgery during the infantile and early preschool period.
3. Speech: Severe hypernasality was evident.
4. Facial appearance: Analysis of Moir e topography indicated the deviation of tip of the nose to the non-cleft side.
5. Function of the tongue during swallowing: Since the lip, alveolus and palate were kept wide open, the usual stripping action of the tongue was not observed but peculiar movement of the tongue was evident. That is, according to the cine-radiography, dorsum of the tongue w as elevated to seal the cleft and food was kept on the floor of the mouth at the first phase of swallowing. Food was, then, swallowed along the lateral margin of the tongue. According t o the EMG activity of the tongue during swallowing, extremely long period of time was necessary for an act of swallowing in comparison to the non-cleft subjects. The pattern of the EMG activity was found to be polyphasic which was not common in the non-cleft subjects.

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Dental caries is a serious problem for cleft lip and palate children.
The authors have done a survey of the incidence of caries in the deciduous teeth of cleft lip and palate patients.
The subjects were 138 children with cleft lip and palate who visited the Department of Oral Surgery, Sapporo Medical College Hospital.
The results were as follo ws:
Until 2 years of age, the prev alance rate of dental caries in children with cleft lip and palate was higher than that in normal children. After 3 years of age, however, the caries prevalance rate was of the same level for both children with cleft lip and palate and normal children.
On the other hand, cleft lip and palate children did have a larger number of treated teeth than normal children.

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Records of 2,548 cases of the cleft lip and/or cleft palate who had visited to the clinic of Plastic and Reconstructive Surgery, Showa University Medical Hospital in the period from 1970 to 1981 were analyzed to investigate the associated anomalies with cleft lip and/or cleft palate.
Five point fourteen percent of all the cases were associated with some other anomalies. The highest incidence of associated anomalies was found among the patients of cleft palate alone (14.2%), in those with cleft lip and palate, it was 6.01% and in those with cleft lip apone,2.35%.
The anomalies frequently associated were inguinal and/or umbilical hernia, congenital heart disease, Pierre Robin syndrome, extremity deformity, ear deformity, ankyloglossia, transverse facial cleft and oblique facial cleft.
Comparing to tho gene ral population, these patients with cleft lip and/or cleft palate are suffered frequently from these subsequent disease: congenital heart disease, Pierre Robin syndrome, extremity deformity, microtia, transverse facial cleft and oblique facial cleft.

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Among the patients who visited the Second Department of Oro-Maxillo-Facial Surgery, Aichi-Gakuin University School of Dentistry,272 of them had cleft lip,307 had cleft lip and palate, and 129had cleft palate. The total number of patients was 708.
All patients were born between 1972 to 1981 and underwent a primary operation at our department. All of the patients were examined with respect to seasonal changes, and the seasonal changes were compared with those of the frequency of birth of Japanese children obtained from the Population Dynamics compiled by the Statistics Information Division of the Health and Welfare Statistics and Information Department, Ministers Secretariat, Ministry of Health and Welfare.
The results showed that seasonal change of the incidence of cleft lip was comparatively similar to that of cleft lip and palate, but different from that of cleft palate.

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The clinical statistics of 232 patients with cleft lip and cleft palate hospitalized in our department from April 1,1981, to March 31,1982, was investigated. The data of these patients were compared with the data of 999 patients with the same symptoms hospitalized in our institute in the past five years.
The results revealed were as follows:
1. The ratio of patients with cleft lip and cleft palate admitted to our department constituted 61.7%of all our patients.
2. The ratio of patients 0 to 2 years old was 62.2%.
3 The mean body weight of the patients with these symptoms at birth, as compared with that of the controls, was lower in all the groups.
4 The description in the current s tandard at the time of the primary operation should be reinvestigated.
5. The ratio of patients who underwent primary operation, classified according to the type of cleft, was 30.5 % for cleft lip,51.8% for cleft lip and cleft palate, and 18.4% for cleft pal a te, respectively.
6. The surgical methods used for the primary operations were examind and readjusted.

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With a view to discover the mental state and attitudes of the families of children with cleft lip and palate, questionnaires were sent to the children's mothers for a survey, and the following results were obtained:
1. The mother of such children were very much disturbed immediately after giving birth, and their mental state was unstable. About 30% of the mothers of children with cleft lip or cleft lip with cleft palate were troubled with the thought of suicide.
2. The mother uneasiness was clearly diff erent according to the types of cleft in children before they received treatment. The mothers who had children with cleft lip were more anxious than other group.
3. The attitudes of the fathers and their parents were divergent but attitude s of the mother's parents were generally constructive.

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