Quantitative measurement of lateral pharyngeal wall movement is necessary to evaluate the degree of velopharyngeal closure in patients with cleft palate and other velopharyngeal incompetency. Various methods involving video or cineflurography have been utilized to determine the configuration and movement of the lateral pharyngeal wall during speech and other activities. However, those have not always revealed the nature of the entire lateral pharyngeal wall because of the bony structure overlying the pharynx. In 1975, Skolnick et al. reported preliminary inventigations of a new technique using multitransducer ultrasonic equipment to assess the dynamics of lateral pharyngeal wall movement, but no reports have been published dealing with quantitative studies of lateral pharyngeal wall movement in cleft palate patients using this equipment.
The purpose of this report is to exhibit the utility of multitransducer ultrasonic equipment for the diagnosis of velopharyngeal function in cleft palate patients and velopharyngeal incompetence patients. Five patients with repaired cleft palate (one male and four females 15-33 years. ), three patients w ith unrepaired cleft palate (all females 32-52 years), four patients with congenital velopharyngeal incompetency in the absence of a repaired cleft palate (two males and two females 13-20 years) and five normal subjects (one male and four females 27-32 years) were used as subjects for these experiments. Each subject sat in a dental chair with head immobilized so that the hard palate was positioned approximately horizontally, and the vowel /a/, /i/, and swallowing.
Each case of cleft palate and velopharyngeal incompetency showed uncoordinated activity in the lateral pharyngeal wall during phonation, but with a similar pattern in comparison with normal subjects. During swallowing, the medial movement of the lateral pharyngeal wall was comparable to that of normal subjects. In all cases, the clearly observal information provided by the echograms suggests that use of multitransducer ultrasonic equipment to assess the dynamics of lateral pharyngeal wall movement may be successfully applied in quantitative studies involving cleft palate and other velopharyngeal incompetency.

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Ultrasonic examination was applied to assess the nasopharyngeal function. The present report shows the results of a basic study on ultrasonic observation of the lateral pharyageal wall (LPW) in normal subjects by means both of real time ultrasound scan and M-scan.
1) Analysis of the nasopharyngeal closure p osition in lateral and posterior-anterior cephalometric radiograph shows that the maximum medial excursion of the LPW occurs at the level of the full length o f the elevated velar.
2) The ultras ound crystal was placed against the neck at a position slightly under the ear and behind the ramus of the mandible. So that the ultrasonic beam would be directed toward the LPW position, the re must be an angle of 10°-16° against frontal plane and 18°-20° against Frankfort horizontal plane.
3) The dynamic movement of LPW during speech, as viewed by the real time ultrasound scan, was very similar to that seen on a frontal video-fluoroscopic examination.
4) During the production of /a/, the medial movement of the upper level of the LPW is seen, and the LPW is shaped like an arc. However, the /i/ vowels showed an upward vertical and /or slight lat e ral movement of the lower part of the LPW, so the LPW is shaped like an inverse S.
5) Blowing showed the same patterns of medial movement of the LPW during pron unciation. However, during swallowing, medial movement is different from pronunciation, and maximum medial exc u rsion of the LPW over a wide extent is seen.
6) The M-mode echo curve allows the relative displacement of a reflecting interface of the LPW at the region of the nasopharyngeal closure, and is measured by quantitative analysis.
7) There was a tendency for the moved distance of the LPW for swallowing > plosive consonants and blowing > vowels > nasal consonant.
8) The starting point of the LPW movement occurs before the beginning of voice, and the point of maximum movement is observed in vowels after, and in plosive consonants before the beginning of voic e.
9) The speed of the medial movement of the LPW could calculated in the M-mode echo curve.
10) The time for swallowing was 1341msec on average.
11) Both the real time ultrasound scan and M-scan proved to be useful in diagnostic analysis qualitative and quantitative.

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The succinic dehydrogenase activity (S. D. H. ) of the metabolic enzymatic system was studied using orbicular muscles of rabbits of 0-180 days old in an attempt to clarify functional changes following the growth of muscles orbicularis oris.
As a result, we were unable to classify the fiber type since the S. D. H. activity was still low immediately after birth and no muscular fibers were functionally differentiated yet. However, it was found that S. D. H. activity became higher thereafter and functional differentiation was completed approximately 30 days after birth.

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Systematic articulation training was performed on eighty children with cleft palate, between ages four and six who showed improvement in articulatitory proficiency.
Results of the training were analyzed and com pared with (1) age of primary palatoplasty, (2) velopharyngeal closure function, (3) number of error sounds, (4) type of articulation and (5) intelligence.
In addition, other factors likely to be related to the results such as age at start training were also discussed.
The results are as follows:
1) One year old children wi th primary palatoplasty required fewer training sessions for articulation improvement than those two years old or above with primary palatoplasty.
2) Children with complete velopharyngeal function closure showed remarkably better tranining results than those with marginal velopharyngeal function closure.
3) Children with less error sounds showed fewer training sessions than those with many error sounds
.4) Children with palatalized articulation needed more training than those with glottal stop. There were significant difference in palatalized articulation and glottal stop among f our year olds.
5) There were differences in training results of children with glottal stop according to the de gree of velopharyngeal closure function.
6) Children with high verbal intelligence needed less training than those with low verbal intelligence.

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As cleft palate children learn nomral articulation during period of echoic utterances which is seen in almost every child as a stage in linguistic development process, operation on cleft palate should be performed prior to the onset of echoic utterances from articulatory point of view. we investigated at which level of developmental stages children begin to use echoic utterances in order to determine the appropriate time for the operation.
1) Subjects: 51 cleft palate children, their ages ranging from one year 4 months to two years 8 months. Developmental quotient was 95.4 (S. D.13.56), and distribution was normal.
2) Method: Echoic utterances, language expression, operati onal skills and wit were studied. Chi-square test was administered while correlations between these factors and echoic utterances were examined taking developmental and chronological ages into consideration.
3) Results: Items which were in correlation with the onset of echoic utterances were as follows.
a) ability to use at least 8 meaningful words.
b) the beginning of ability to manipulate a doll meaningfully.
c) the beginning of ability to show wit in behavio r.
d) developmental age reaching one year 8 months.
Chi-square test revealed a significant difference at 1% level of confidence.
The results indicated that these indexes appear to be effective in deciding the appropriate time, which is considered to be before the onset of echoic utterances, for plastic surgery on cleft palate. However, no correlation between chronological age and the onset of echoic utterances was found and significance of difference was not seen.

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Palatal push back method has been used widely for cleft palate repair. Although the main aim of palatal push back method is retropositioning of the velum, velopharyngeal insufficiency is sometimes observed after the operation in the case of long vertical distance of the velopharyngeal space. We describe a new method called Palatal Pull Upward Method in order to shorten the distance. In this method, the mucosal flaps on the soft palate are turned over and sutured to the cranial base of the nasal septum, thus pulling the velum upward toward the pharynx. The sling of the levator muscle is also reconstructed. Therefore, the palatal pull upward method reduces the vertical distance of the velopharyngeal space and coincides with the levator muscle function.

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We investigated brachydactylic change and the variation of carpal bones in 115 patients with cleft lip and cleft palate (from 6 to 12 years old) according to the method of Sugiura.
Results: 1) The incidence of brachymesophalangy of the little finger with cleft lip and palate was higher than with normal, and it appeared frequently in patients with bilateral cleft lip and palate.2) The incidence of pseudoepephysis of the metacarpals with cleft lip and palate was almost the same as normal in males, but was higher than in normal females.3) The cases of 1. Double ossification conters in the epiphyseal cartilage of the Ulna,2. Double ossification conters in the epiphyseal of the tranpezoideum,3. Brachytelephalagy of the phalanx distalis of the fifth finger, and 4. Multiple cartilagious exstosis, which were rare skeletal changes, appeared in the patients with cleft lip and palate. The incidence of carpal bone change in the patients was higher than in normal persons.

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Dysarthria due to velopharyngeal incompetence arises from organic abnormalities such as cleft palate and trauma in a majority of cases, but from various functional defects without organic abnormalities in others. Spurious paralytic dysarthria in myasthenia gravis, which belongs to the latter category, presents interesting developments in the state of impediment. We studied fluid dynamics of phonation in a 16-year-old female patient with spurious paralytic dysarth-ria due to velopharyngeal incompetence derived from fatigue, and concluded that fluid dynamic evaluation of velopharyngeal function serves as a useful index in diagnosis and clinical observation of the patients with this diseases.

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A survey on cleft lip and/or palate incidence has been conducted on 343 obsterical and gynecological clinics for 1981 and 1982.
1. Incidence: From the 133,042 birth records,217 infants with cleft lip and/or palate were identified. The incidence was 0.163%.
2. The order of cleft frequency was lead by cleft lip and palate followed by cleft lip only and cleft palate only.
3. Sex ratio: All clefts were more frequent in male than in female.
4. Cleft side: Unilateral clefts were significantly predominant over bilateral ones, and left side clefts were significantly more frequent than right side ones.
5. Birth weight and period of gestation: The frequency of births weighted under 2,500 g and preterm delivery in cleft lip and/or palate subjects was significantly higher than that of control subjects.
6. Associated malformations: percentage of associated malformations with cleft including still-birth was 21.3%, and highest in cleft palate alone. Malformations most commonly associated were abnormalities of limbs, micrognathia, heart malformations and anecephalus.

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University Hospital, during the period January 1976 to March 1984. To assess the current situation of the demand for orthodontic treatment, the cleft patients were examined with relation to such variables as age, stage of dental development, type of cleft and malocclusion.
The following findings were observed.
1. The total number of cleft cases were classified according to cleft type as follows: 17 cases (13.5%) in cleft lip and/or alveolus (CL),71 cases (56.3%) in unilateral cleft lip and palate (UCLP),19 cases (15.1% ) in bilateral cleft lip and palate (BCLP) and 18 cases (14.2%) in isolated cleft palate (CP).
2. According to age distribution, over 60% of the cleft patients were found in age range 6-11 years. However, a high percentage of patients of 15 years old or above was noticed in cleft lip group.
3. The frequency distribution of patients by dental development stage revealed more than half of them visited the orthodontic clinic during the period of the deciduous and early mixed dentition.
4. Characteristics of occlusion in the cleft patients were the severe cross-bite and teeth crowding in the anterior and posterior segments of dental arches. In cleft lip group, on the other hand, alignmen t anomalies restricted to individual teeth were more common than occlusal anomalies.
5. A marked increase of the number of the cleft patients was shown during last two years (1982-1983) and, consequently, the cleft cases comprised about 30% of the orthodontic cases.

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This paper dealt with the statistical analysis of cleft lip and/or palate patients in the Orthodontic Clinic, Hokkaido University Dental Hospital.
During 15 years from 1969 th rough 1983,276 patients consisting of 147 males and 129 females were treated in our clinic. Those patients were 10.4 % of total patients. The age at first visit ranged from five to 28years of age, and 72.1 % of those patients came in at ages between five to ten years.
The patient's distribution following type of cleft was as follows:
UCLP (L) 42.0 % UCLA (L) 6.5 %UCLP (R) 16.3 % UCLA (R) 3.6 %BCLP 14.1 % BCLA 1.5 %CP 14.9 % CL 1.1 %
Associated crossbites were found in 93.1 % of the patients.

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