We have long history about the cleft surgery. I described about the primary palatoplasty on this paper. At the present, two major surgical procedures of primary veloplasty are performed in the world. One is Wardil-Kilner push-back method, and another is Furlow method. Primary palatoplasty is most important surgery among the cleft surgeries. Primary palatoplasty will decide many factors which influence on the oral function and post surgical development. I explain the details about these two surgical procedures for the young oral surgeons to develop the new approach of cleft palate. And also I will show how maxillary development is recognized when the periosteal damage is very limited at the primary palatoplasty. I describe our labial vestibuler mucosal flap technique.

Bone grafting of the jaw fistula transplants autologous bone to patients with cleft lip and palate. The secondary bone graft is a method to obtain the continuity of the bone in the alveolar rupture. The secondary bone graft for the cleft lip and palate was reported as a method aimed at occlusal construction that enabled the guidance of teeth to the cleft palate, not for filling the gaps in the cleft palate, and with good maxillary alveolar arch form. The secondary bone graft is standardized. However, it is not only necessary for the transplanted bone to engraft in the cleft palate, but it is also necessary to form a bone bridge with a certain height and width of the alveolar for that purpose. A team approach with an orthodontist is an essential way to obtain an occlusion. This manuscript described the purpose and technique of cleft palate bone grafting.

In orthognathic surgery for jaw deformity caused by congenital or acquired factors, the presence of scar tissue makes it difficult to move bone segments and easy to bring on relapse.

　Maxillary distraction is increasingly used for the correction of severe maxillary retrusion in patients with cleft lip and palate.

　A two-stage surgical approach consisting of maxillary distraction and mandibular setback was used to correct jaw deformities with severe maxillary retrusion secondary to cleft lip and palate. These procedures resulted in stable occlusion and an improved facial profile.

　On the other hand, mandibular distraction for Hemifacial macrosomia and/or Progressive Condylar Resorption (PCR) should be considered carefully.

Recently, methotrexate-associated lymphoproliferative disorders (MTX-LPDs) have received attention as a disease concept in the oral and maxillofacial region. Most cases show histopathological Epstein-Barr virus (EBV)-positive B-cell lymphoma, with spontaneous resolution observed following the cessation of MTX. We herein report a case of T-cell MTX-LPD of the tongue that was negative for EBV and showed a CD4− CD8− double negative T-cell histology. A 70-year-old woman was referred to our hospital with the chief complaint of an intractable ulcer of the tongue which had existed for approximately one month. Examination revealed a 20×10 mm ulcer on the right inferior surface of the tongue. She had a medical history of rheumatoid arthritis treated with MTX. We diagnosed her with EBV-negative, CD4 − CD8 − double negative T-cell MTX-LPD, based on the findings of a blood biochemical specimen and tissue biopsy. The tongue lesion showed spontaneous resolution after MTX withdrawal. The course was uneventful, and there was no evidence of recurrence of the lesion at one year after the withdrawal of MTX.