The purpose of this paper is to clarify whether the difficiency and excess of the tissue exsit on the nose and upper lip in the unoperated unilateral cleft lip patients, and to elucidate the change of tissue-volume of the nose and upper lip before and after the primary lip repair. The faicial plaster casts were made by no-pressure impression taken under endotracheal anesthesia immediately before the lip repair in 70 complete unilateral cleft lip patients and 60 incomplete unilateral cleft lip patients. In 73 out of these 130 patients, the facial plaster casts were made immediately after the lip repair by Tennison-Randall's or Millard's method.
The surface areas of the nose and upper lip were measured by Huddart's method adapting a piece of soft resin sheet to the faicial plaster cast using pressure moulding technique. The surface areas of the dorsum nasi and nose on the cleft side were significantly greater than those on the noncleft side in both complete and incomplete cleft lip. On the contrary, the surface areas of the nasal ala, skin portion of lateral upper lip, philtrum skin portion of upper lip and skin portion of whole lateral upper lip were significantly smaller on the cleft side than on the noncleft side in both complete and incomplete cleft lip. The surface area of the skin portion of whole lateral upper lip was distinctly smaller on the cleft side than on the noncleft side in complete cleft lip, but these found no difference in the incomplete cases. The surface areas of the nasal ala, nose, skin portion of lateral upper lip and skin portion of upper lip on both the cleft and noncleft sides, the skin portion of whole lateral upper lip and philtrum on the cleft side, and the dorsum nasi and nose on the noncleft side were significantly narrower in complete cleft lip than in incomplete cleft lip. The surface areas of the dorsum nasi and nose on the cleft side were significantly greater in complete cleft lip than in incomplete cleft lip.
Immediately after the operation, the surface areas of the nasal ala, nose on the cleft side and the philtrum on the noncleft side decreased distinctly in complete cleft lip, but the surface areas of the nasal ala on noncleft side, skin portion of lateral upper lip and skin portion of upper lip on both the cleft and noncleft side, and the philtrum and skin protion of whole upper lip on the cleft side increased clearly in complete cleft lip. Postoperatively, however, the surface areas of the dorsum nasi, nose and skin portion of whole lateral upper lip on the cleft side decreased distinctly in the incomplete cleft lip, but the surface area of the philtrum on the cleft side increased. The same tendency of change of the surface area on each portion was observed in both Tennison-Randall's and Millard's method, but the amount of change of the surface area was different in those methods.

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From 1974 to 1982, we have performed primary repairs on 126 pati ents with bilateral cleft lip. In these patients,11 pedigrees have two affected children, involving at least one of bilateral cleft lip in same siblings. We have studied statistical analyses on these patients, based upon birth order, type of cleft and sex. The results are as follows:
1. There are more cases in the group, where the older sibling has unilateral cleft lip and the younger sibling has bilateral cleft lip than in the group with the reversed conbination (i. e. older sibling has bilateral cleft lip and young er one has unilateral cleft lip) (p<0.05).
2. There is no relation between birth order and sex in this study.
3. In the group, where older sibling has a unilateral cleft lip and the younger one has bilateral cleft lip;
a) there is good relationship between birth order and sex (p<0.10).
b) there are more cases with male-to-male combination (p<0.05).
Analyses on 2532 cases of cleft lip and palate have been report ed by Sanui in1962. In this report, we have seen the similar finding in 10 pedigress just like our cases. We have also analysed on the total 21 cases from our study and Sanui's report. The results were similar to our previous case study. On the other hand, statistical analyses of Sanui'ss cases alone did not produce the results that we obtained in our cases alone.

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Patients diagnosed as congenital velopharyngeal incompetence (CVPI), including so-called submucous cleft palate, frequently exhibit mental retardation besides articulation disorders with hypernasality and cardic anomalies. However, there have been relatively few reports dealing with specific relationships between the facial malformities and learning impairments accompanying CVPI.
The subjects of this report werel5 patien ts ranging in the age from 4 years 2 months to 12 years 5 months who had been diagnosed as CVIP by examinations of the velopharyngeal form, velopharyngeal closure and facial characteristics according to our diagnostic criterion.18 cleft lip and palate (CLP) patients ranging in the ages from 4 years 5 months to 13 years 2 months served as the control group, and all were administered the WPPSI or WISCR, the Illinois Test of Psycholinguistic Abilities (ITPA) and the Developmental Test of Visual Perception (DTVP). The patients were divied into groupes following classification on the basis of velopharyngeal form, the tried noted by Calnan, characteristics of the face. The results of the psychological tests of each groupe were then compared with one another.
The results show that the typical facial group achieved lower scores significantly than the non-typical facial group and the CLP group at a.01 level of conficence. Regarding the velopharyngeal form, the type II group in which the length of the soft palate and the depth of the pharynx are disproportional to normal, achieved lower scores than other groups. Regarding Calnan's triad, the patients in the 0-1 triad group produced lower scores than other groups. It was clarified that intellectual impairment was most significantly related to characteristics of the face and velopharyngeal form, but not so much related to the Calnan's triad. These ovservations together with the results of our previous study relating to the velopharyngeal and facial formations associated with CVPI suggest that one independent syndrome exists, whichi includes CVPI, typical facial characteristics and mental retardation.

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A video tape recording system yielding views at 60 fields per second was coupled with a nasopharyngeal fiberscope(NPF) to perform a field by field analysis of velopharyngeal movement.
A simultaneous video-fiberscopy and video-fluoroscopy was used to determine validity of measurement. Eight normal speaking adults were utilized to examine "timing" of velar closure, maximum velar elevation, and maximum lateral wall movement toward a standard time point which was determind as onset of articulatory release or voicing during successive phoniatric event. The speech samples consisted of /a/, /V, /u/, /e/, and /o/ in isolated production, and /p/ in /pa/ and /npana/ productions.
The results indicate the followings.
1) The proposed procedure provides reliable and valid data about continuous changes of velar and lateral wall movements and portal dimension.
2) Using NPF measurements, th e magnitude of movement could be estimated within subject, but not across subjects, because of lack of a scale marker.
4) Analysis of timing of velar closure toward a standard time point appears to be useful for evaluating velopharyngeal closing function among various individuals.

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The purpose of this study was to investigate effects of the maxillary protrac tor on craniofacial growth of patients with operated complete unilateral cleft lip and palate(UCLP).
The subjects consisted of three males and four femal es with operated UCLP and two males and four females of non-cleft cases with mandibular protrusion and undergrowth of the midface. The maxillary protractor was used for both UCLP and non-cleft patients. The lateral cephalograms were obtained before treatment and after normal occlusal relation was acquired or at the phase of treatment when the protractor was used at least two years. The control for the UCLP group was comprised of the orthodontically untreated UCLP patients and the control for non-cleft group was obtained from the growth study materials of Department of Orthodontics, Faculty of Dentistry, Osaka University. The age and sex of each control group were matched with the subjects used in this study.
The following results were obtained.
1. The maxillary protractor was found to be effective for the forward growth of the maxillary complex in both UCLP and non-cleft groups. However, its effect was less in the UCLP group than the non-clef t group.
2. The backward rotation of the mandible, which was generally observed in the non-cleft group as the response to the chin cup of the maxillary protractor, was not always found in the UCLP group.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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