Juntaro Nishio

Early two-stage double opposing Z-plasty or one-stage push-back palatoplasty?: comparisons in maxillary development and speech outcome at 4 years of age.

Determining the optimal timing and procedure of palatal surgery for children with cleft lip and palate has long raised a major controversy. An early two-stage palatoplasty protocol has been a recent trend in an attempt to obtain preferable maxillary growth without compromising adequate speech development. In this study, we aim to address whether the resulting maxillofacial growth and speech development obtained by an early 2-stage palatoplasty protocol are better than those obtained by conventional 1-stage push-back palatoplasty. Seventy-two nonsyndromic children with complete unilateral cleft lip and palate were enrolled in this study. They were divided into 2 groups: 30 children, who were treated with early 2-stage palatoplasty, in which soft palate closure was performed using a modified Furlows procedure at 12 months of age and hard palate closure was performed at 18 months of age (Early Tow Stage [ETS] group: 22 boys, 8 girls), and 42 children, who underwent 1-stage Wardill-Kilner push-back palatoplasty at 12 months of age (Push Back [PB] group: 31 boys, 11 girls). Cephalometric analysis for maxillofacial growth and assessments of speech development were performed for each child at 4 years of age. The ETS group showed a lager maxillary length than the PB group [anterior nasal spine (ANS)-ptm′: ETS, 46.7 ± 2.0 mm; PB, 43.6 ± 2.3 mm]. The ANS in the ETS group was positioned more anteriorly than that in the PB group (N′-ANS: ETS, 2.5 ± 1.8 mm; PB, 0.26 ± 2.5 mm), whereas the posterior edge of the maxilla positioned anteroposteiorly was comparable between the 2 groups. The anterior facial height was significantly greater in the ETS group than in the PB group (N-N′: ETS, 43.3 ± 2.9 mm; PB, 40.1 ± 2.3 mm, S-S′: ETS, 29.7 ± 3.2 mm; PB, 31.0 ± 3.2 mm). No statistically significant differences were observed in the incidence of either velopharyngeal incompetence or articulation errors between the 2 groups at 4 years of age. Our results show that the early 2-stage protocol is advantageous with regard to maxillary growth compared with 1-stage push-back palatoplasty without compromising speech development as evaluated for all children at 4 years of age.

Visual training for velopharyngeal closure in cleft palate patients; a fihrescopic procedure (preliminary report)

Velopharyngeal closure in various tasks was examined in 59 cleft palate patients with persistent velopharyngeal incompetence using nasopharyngeal fibrescopic (NPF) examination. The degree of velopharyngeal closure was analyzed according to the categories reported previously by Yamaoka (1973) and Matsuya et al. (1979). The NPF self-training system was developed and applied to those patients so as to investigate a longitudinal effect of the NPF in velopharyngeal closure mechanism. The training was performed every two weeks for nearly one year. The results indicated that the patient who showed complete velopharyngeal closure during blowing and/or several productions of speech samples could attain a much better improvement in all speech samples after one year of self-training. On the other hand, the patients who did not show complete velopharyngeal closure during all tasks, failed to improve the velopharyngeal closing mechanism. The ability to close the velopharynx during swallowing was seen in all patients examined. However, it appeared to have nothing to do with the prognosis of velopharyngeal closure. The data suggested that the NPF self-training system provided a strong neuro-muscular signal for velopharyngeal movement. Besides, it was considered that the NPF was a useful tool for activation of velopharyngeal activity by way of visual feed-back control.

Respiratory Activities in Relation to Palatal Muscle Contraction

This study investigated the activities of the tensor and levator veli palatini muscles related to respiration. During quiet breathing, no activity was observed in either muscle. With either hypercapnic or hypoxemic condition, the tensor veli palatini muscle exhibited phasic activity during inspiration. The levator veli palatini muscle showed phasic activity during expiration with hypoxemia (PaO2 less than 40 mm Hg). NaCN perfused bilaterally through the carotid sinus induced these respiratory activities. The tensor veli palatini muscle was more sensitive than the levator veli palatini muscle to NaCN.

Metastatic choriocarcinoma involving the gingiva.

A case of metastatic choriocarcinoma involving the mandible is reported. This case is analyzed for the potentiality of immunologic defense by utilizing tuberculin test and scoring the rate of blast formation of peripheral blood lymphocytes by phytohemagglutinin, resulting in a greatly decreased ability of cellular immunity.

12q Interstitial Deletion With Bilateral Cleft Lip and Palate: Case Report and Literature Review

The authors report the case of a Japanese girl with interstitial deletion of chromosome 12q15–q21.2 who had multiple congenital anomalies including bilateral cleft lip and palate (BCLP) with intrauterine onset of growth retardation and severe psychomotor developmental delay. Only two other patients with a similar deletion have been reported previously. However, these two patients showed such different clinical features that defining the karyotype-phenotype correlation has remained unfeasible. The additional case presented here reveals that two of the three cases with an overlapping deletion in 12q show the phenotype of BCLP, suggesting the correlation between this area of gene deletion and cleft lip and palate.

Primary Treatment for Cleft Lip and/or Cleft Palate in Children in Japan

Objective To investigate current trends in primary treatment for children with cleft lip and/or cleft palate in Japan. Design Nationwide, retrospective study under the direction of the Academic Survey Committee of the Japanese Cleft Palate Association based on analysis of data obtained via a booklet-style questionnaire completed by institutions providing primary treatment for cleft lip and/or palate patients. Participants, Patients Patients were 4349 children undergoing primary repair for cleft lip and/or palate at 107 participating institutions between 1996 and 2000. Main Outcome Measure(s) Cleft type, laterality; use of infant palatal plate; and timing and technique of primary repair for cleft lip and/or palate were evaluated by cleft surgeons at 107 participating institutions. Results Of a total of 2874 patients with cleft lip and palate or cleft palate only, infant palatal plates were used with 1087 (37.8%) and were not used with 1787 (62.2%). Primary unilateral lip repair was performed at the age of 2 to 6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2212 (76.9%) and two-stage palatal repair in 262 (9.1%) cleft palate patients. Information on treatment of the remaining 400 (14%) patients was unavailable. Conclusion This investigation clarified current trends in primary treatment for cleft lip and/or palate in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.

Mechanical Contraction Property of the Levator Veli Palatini Muscle

Twenty adult dogs anesthetized with sodium pentobarbital were used as experimental animals in an analysis of the mechanical contraction properties of the levator veli palatini muscle. The following results were obtained: the contraction time and half relaxation time of maximal isometric twitch of the muscle were revealed to be 43 msec and 33 msec, respectively; a summation curve was obtained with stimulation at 15 Hz and maximal tetanic tension was at 70 Hz. The average of the tetanic tension ratio was found to be 5.7. The maximum rate of tension rise was observed at 150 Hz, and the value was twice the rate of the twitch contraction. The duration time of the active state plateau showed values of 3.9 to 4.5 msec. The contraction time of the levator veli palatini muscle closely resembles that of the intrinsic laryngeal and the orbicularis oris muscle.