This paper deals with the cleft lip and palate patients who have been seen in the orthodontic clinic of Iwate Medical University School of Dentistry, since 1965 to 1979.

Recently, there have been increasing the patients with cleft lip and palate in our orthodontic clinic. Fifty-eight percent of patients are uni-lateral cleft, but most of them appear to be retarded development in their maxilla. In these cases, the improvement of facial appearance and occlusion is difficult, but it would not be avoidable their treatment. Therefore, it should be concerned that the early treatment and longitudinal management of oral health care are necessary.

We described the management in orthodontic treatment of the patients with cleft lip and palate in our orthodontic clinic.

The authors collected 366 cases of malignant pharyngeal tumors (MPT) that occurred during five years from 1972 to 1976 from the annuals of the pathological autopsy cases in Japan. The MPT cccurred in male (268 cases) more often than in female (98 cases) (P<0.01). The MPT was found most frequently in the seventh decade, and the incidence ill these ages to all cases was 32.8 per cent (120 cases). The average age of the patients of all cases was 56. 0 years (male:57.1 years, female: 53. 0 years). The epipharynx was most often affected in the pharynx (149cases). Histopathologically 256 cases of all cases (69.9%) showed squamous cell carcinoma.The lungs were by far the most common site of metastasis from the MPT (158 cases), followed by liver, neck, and bone. Concerning the metastasis from the MPT into the lymph node, the cervical lymph nodes were most numerously invaded (149 cases). Multiple primary cancers affecting both the pharynx and the other organs were found in 32 cases (double cancers: 30 cases, triple cancers: 2cases). Pneumonia was the most frequent complicated lesion (42.1%), and the other complications were the bursting of cervical blood vessels, nephritis, pulmonary tuberculosis, and liver cirrhosis.

A case of maxillary fracture treated with open reduction using pull-out wire has been reported.

A 19-year old man hit his face to the wooden fence from the running car on Oct. 30, 1978. Immediately, he came to the emergency room of our hospital complaining of facial lacerated wounds and maxillary fractures. Clinical examination showed diffuse swelling of the middle facial region and severe oppressive pain was found on the right zygomatico-frontal, nasal region. Intraoral examination revealed the dislocated maxillary bone toward posteriolly and ege-to-ege occlusion. His upper jaw moved back and forth as en bloc. He could not open his mouth beyond 1.5cm. Radiographical findings revealed the type of maxillary fracture of Le Fort I+Ⅲ on the right side and of Le Fort I+Ⅱ on the left side.

The patient was admitted to the hospital immediately, and the first aid treatment was done. After 11th day, open reduction of maxilla was performed under general anesthesia. One-piece-casted splint was cemented on the upper dental arch and fixed with cranial suspension wire. For intermaxillary fixation, continuous wiring was applied to the lower dental arch. End of pull-out wire was retained in the fore-head region through button of Y-shirt. Radiographical findings after operation showed good reposition and fixation.

Forty days after the operation, intermaxillary fixation was removed and cranial suspension wire was pulled out without trouble under local anesthesia. Prognosis has been very evenful and occlusion has been improved to the normal position.

A case of chronic osteomyelitis of mandidle treated with decortication has been reported.

A 20 year old man was reffered to our clinic with a chief complaint of swelling of the right mandible and trismus. The patient stated that these symptoms were repeated from the time to time, simultaneously with osteomyelitis of his right tibia, for the past four years. Ciinical examination showed swelling of the right mandible angle extending to submaxillary region. There was hard induration of this area and radiographic findings showed typical chronic osteomyelitis of mandible.

The patient was admitted to our hospital and started on massive antibiotic therapy, but it had not taken effect enough. Then, with the patient under general anestesia, decortication was performed by extraoral procedure with primary closure of the skin wound. Postoperative course was unevenful.

At two years after the operation, radiographic findings showed regeneration of the bone with normal trabercula. Histological findings of removed specimen showed typical chronic sclerosing osteomyelitis.

Some Patient are too much afraid of dental treatments, and the treatments under local anesthesia have to be ofen stopped by their cerebral anemia. To treat such patients, we tested the effect of an intravenous injection of tranquilizer, diazepam, with 14 patients, and it was found to be satisfactory as already reported by others.

(1) After the injecting none of significant change was observed in respiration, pulse and blood pressure.

(2) The surgical operations had not to be interrupted by the patients complaints about pains.

(3) An amnesic effect of the drug led the patients to feel the duration to be shorter than the leal operation peliod.

(4) The patients were allowed to leave the hospital after about 2.5 hours from the beginning of treatments, similarly to other reports.

(5) After the treatment some of patients complained about a prolonged sleeping, fatigue and dizziness, but none of severe ones.

(6) 12 patients wished the injection of the drug in future dental treatments.