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.

An anatomical study of vascularized iliac bone grafts for dental implantation.

PURPOSE: The purpose of this study was to clarify the anatomical features of vascularized iliac bone grafts used for mandibular reconstruction and dental implantation. MATERIAL AND METHOD: Twenty-six cadavers were dissected to examine vessels and areas of iliac bone that could be used as pedicles and grafts. The length and diameter of vessels of the vascular pedicle were determined, and the length and depths of the iliac bone were measured with respect to points determined by the relative dimensions of the bone. RESULTS: The deep circumflex iliac arteries were classified as double nutrient type (75%), iliac-crest type (19%), or iliacus-muscle type (6%). The mean arterial length was 64+/-15 mm in the double nutrient type. The mean internal diameters at the origin of the deep circumflex iliac artery and vein that could be used for anastomosis were 1.7+/-0.4 mm and 2.1+/-0.7 mm respectively. The greatest mean cross-sectional width and height were 18+/-3 and 42+/-5 mm respectively. The greatest mean cross-sectional cortical thickness at the intermediate line of the iliac crest was 3.4+/-0.8 mm. CONCLUSION: These results should be useful in designing bone grafts for mandibular reconstruction followed by dental implantation.

Clinicoanatomic study on the craniofacial bones used for cranio- and maxillofacial implants.

PURPOSE: To clarify basic clinico-anatomic factors associated with cranio-maxillofacial rehabilitation using implants. MATERIALS AND METHODS: Morphometrically evaluated were items such as the length and width of bone and the thickness of cortical bone at important sites for implant placement into cranial and maxillofacial bones in 30 cadavers at autopsy. RESULTS: At sites corresponding to potential placement sites for implants as the fixation source for ocular epitheses, the mean length of bone was 7.8 mm, and the mean width was 8.3 mm. CONCLUSION: Useful data have been obtained for the selection of the placements sites, direction, length, and external diameter of cranio- and maxillofacial implants.