The upper labial scars from the secondary repair of sixty cleft lip patients were studied by optical micro scope and scanning electron microscope. In addition, twenty-five normal skin pieces surrounding the scars were observed as controls.
Under optical m icroscopic observation, epithelium, granular cell layer and spinous cell layer of the scars were slightly thinner than those of controls, but the horny layer seemed to be thicker. The scars were classified in three types according to fibrous structure. Type 1 had a superficial layer consisting of collagen fibers, and a profound layer consisting of collagen bundles. Type 2 mostly consisted of collagen fibers, and had no obvious border between the superficial layer and the profound layer. Type 3 mainly consisted of collagen bundles, and had no obvious border between the superficial layer and the profound layer.
In scanning electron microscopic observation, dermatoglyphics formed from the principle s u lci cutis and crista cutis appeared to be less, but secondary sulci cutis appeared to increase in the scars as compared to the controls. The condition of disjunction, border and step-like shadow depression of the squamous cells were more complicated in the scars. The scars had branched microridge, microridge, microvilli, micropit and irregular wrinkle as the first relief of squamous cells. In the scars of type 1, collagen fibers and collagen bundles were more irregular in size, more increased in density and curved. The scars of type 2 had almost no collagen bundles and were mainly formed by collagen fibers and fibrils. There were less collagen fibers made by aggregation of collagen fibrils in type 2 scars. The scars of type 3 were formed from laminal collagen bundles and some of the scars showed an amalgam-like appearance from the confluence of collagen bundles.
There were very few hair bulbs, sebaceous glands and sweat glands which were accessory organs of the skin. Hair shafts in the scars varied greatly in size and appeared on crista cutis.

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To elucidate the physical growth and development of patients with cleft lip and/or cleft palate, the authors looked up the physical examination data at birth in the "boshi-techo", a notebook for mother and child, on physical examination visit and took a bilateral carpal bones roentogenogram. Studies were made of 115 patients with cleft lip and/or cleft palate that were seen at the Division of Speech Therapy, Department of Oral Surgery, Nagoya University Hospital. Physical examination data were compared with the average of the neonates reported in 1969 in Japan by the Ministry of Health and Welfare plus the average from 1980school health statistics. The bone maturity was assessed by bone age index according to Sugiura's method using a hand roentogenograms.
Results were as follows:
1. At birth, patients with cleft lip and/or cleft palate were not significantly different in physical examination when compared with the Japan average neonate.
2. On visit, patients with cleft lip and/or cleft palate in each age tended to lower height, lighter weight and smaller chest girth in both sexes as compared to the average.
3. Bone index of patients with cleft lip and/or cleft palate based on the ossification of carpal bones tended to be higher than that of healthy children of same age, but not significantly in developmental stat u s.
4. In comparison of the biological age of patients with cleft lip and/or cleft palate in each age, the most accelerated development was observed in bone, followed in height and the most delayed development was in weight.
5. Concerning development abnormality based on Fanconi's index, most abnormal acceleration of development was observed in bone, but on the contrary the most abnormal delay of development was in weight.
6. Patients with cleft lip and/or cleft palate ranging from 6 to 12 years old tended to small and lean bodies.

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It is not rare that patients with cleft lip and/or palate have other accompaning anomalies. Many cases have already been reported, many with anomalies of heart and facial organs, or other parts of the body. We experienced 2 patients, one had a bilateral cleft lip and palate with liver herniation of the thoracic cavity and the other had cleft palate with complete adhesion of the labia minor except the urethral orifice. We have never seen a report of cleft lip and/or palate with these anomalies. For this reason we offer this report.

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Oro-nasal fistula is often found in the alveolar region after cleft lip and palate repair. For this problem, in 1939 V. Veau. reported the method of closure of the cleft of alveolus and anterior palate with vomer flap and palatal flap at the time of lip repair. Thereafter, some people studied or improved this method. However, after closure of the alveolus and anterior cleft palate, much raw surface is exposed on the oral or nasal side, and sometimes a lip deformity results from lip contraction.
Thus we use a vomer flap combined with lip repair for closure of the alveolus and anterior cleft palate, and LPS (Lyophilized Porcine Skin) is applied to the raw surfaces of the oral side.
In repairing alveolar cleft, a mucoperiosteal flap is made at cleft side and a vomer flap at the non-cleft side. These flaps are turned over and sutured to close the nasal floor, alveolar cleft and anterior palate cleft. Then LPS is applied to the raw surface of the oral side and after suturing around, roll gauze is put on and pressed by the tie over method. The roll gauze is removed 4 days after operation, and about 7 days after that, gradual melting of the surface of LPS is observed. Epithelisation of the raw surface is almost completed about 14 days after operation.
1 year after opera t ion, when the palate repair is done, the alveolus and anterior cleft palate are closed completely and the alveolar arch form is good. The results are satisfactory.

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A clinico-statistical investigation was carried out on 222 patients with cleft lip and cleft pa late who had undergone a primary operation at the Department of Dentistry and Oral Surgery, Faculty of Medicine, University of the Ryukyus during the 8 year period from September,1973 to August,1981.
1. There were 137 males and 85 females, with male to female ratio of 1.6: 1.
2. Cleft morphology was classified as follows: cleft lip only and/or alveolus in 68 cases (30.6%), cleft lip and palate and/or alveolus in 113 cases (50.9%), and only cleft palate in 41 cases (18.5%).
3. Unilateral cleft lip and/or alveolus and palate were seen in 128 cases, and a bilateral condition in 53 cases, with a ratio of 2.4: 1. In the 128 cases, ratio of the affected side was illustrated as 1: 2.3 in this rig h t to the left side.
4.11.2% of 205 patients had a birth weight of 2500 or less grams. It was found that 5.7% of all 212 mothers were aged 40 or older at subject's birth.
5. Familial occurence was found in 49 of 209 families of the propositi (23.4%). Nine familial correlations of types of abnormalities between the propositi and affected parents and affected siblings were analyzed. These results were the same as those initially described by Fogh-Andersen.
6. In the siblings of the patients with normal parents, one affected sibling was seen in the propositi with cleft lip and palate, and another in the propositi with cleft palate. There were 8 families which had one par ent affected.

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This study was conducted to get a better understanding of cleft lip and palate, and obtain basic data on their recognition. Questionnaires were distributed to 1,712 parents of elementary school pupils in Nagoya. One thousand six hundred and eight replies (93.9% collection rate) were obtained. Examination of the answers as to whether there were any differences due to various factors regarding the acceptance of this disorder by the general public was made and the following conclusions were obtained:
1. No difference in common knowledge according to sex was noted, but common knowledge increased with increased education (the number of years of school-ing) of and the age of parents. A difference accord i ng to occupation and living quarters of parents was also found.
2. In those who held a pessimistic outlook of the prognosis of this disorder, no difference according to sex and age was found, but it was discovered that when the education (years of schooling) of the parents w as low, the number of parents with a darker outlook was higher also. A difference according to occupati o n and living quarters was observed.
3. Among the patients with this disorder, an impression of 'feeling sick', which is considered to give the gravest spiritual shock to patients and their families, was held by very few, while in those who wou ld assume a positive support of them, no difference according to sex and age was found, but a correla tion with the number of years of schooling was recognized, i. e., the higher the education, the higher the ratio. The differences according to occupation and living quarters were varied.
4. The majority of the questionees expressed anxiety about the future marriage of these patients as a social disadvantage, followed by their concern about the patients' first impressions and about the marriages of patients' brothers or sisters, but the sex difference was small. The figure increased with the number o f years of schooling, however.
As has been explained so far, the recognition of this disorder was found to be more closely related to the number of years of schooling of parents rather than to sex or age. It was suggested, accordingly, that better recognition of cleft lips and palate by the general public depends on education (enlightenment) regarding this disorder as well as related diseases during elementar y and secondary education.

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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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