Korean Cleft Lip and Palate Association (KCLPA) was founded in 1996. The first overseas charity operation was in Karachi, Pakistan, 2002 and our association has visited fourteen times in six countries for the free cleft surgery: Pakistan, Egypt, Kenya, Morocco, Jordan and Vietnam. The cumulated number of operated patients reaches to 280. Before our association, many Korean oral and maxillofacial surgeons have performed charity operations individually since 1964. It was started from Vietnam but the activity is now carried on in Africa, middle-east Asia, south-east Asia, China, and Korea as an official team. LG electronics, a Korean company helped to propagate our team's activity to middle-east Asia to Africa. This paper is a report concerning about the results of our association's charity activities especially in Kenya, east Africa. We provided free cleft surgery for 30 patients in 2004 and 27 patients in 2005, in Nairobi. As the blood test for HIV of the cleft patients was not allowed before and during surgery, our surgeons and nurses were cautious about every movement during the surgeries. Thus the operation time for each patient was longer than any other time. The attitude of the local hospital and the doctors seemed to be accustomed to this situation. They helped us in case of needle injuries. Safety of medical staff and patients is more important than the number of the patients operated in charity operation. This belief should be approached being parallel and multidisciplinary as an international cooperation, focusing on international funding for medical support and continuous education for local doctors who are willing to devote to their people.
Submucosal type cleft palate is subdivision of the cleft palate. It is very difficult to find submucosal cleft, because when we exam submucosal type cleft palate patients, it seems to be normal. But in fact, there are abnormal union of palatal muscles of submucosal type cleft palate patients. Because of late detection, the treatment - for example, the operation or the speech therapy - for the submucosal type cleft palate patient usually becomes late. Some patients visited our hospital due to speech disorder nevertheless normal intraoral appearance. After precise intraoral examination, we found out submucosal cleft palate. We evaluated the speech before and after surgery of these patients. In this study, we want to find the objective characteristics of submucosal type cleft palate patients, comparing with the normal and the complete cleft palate patients. Experimental groups were 10 submucosal type cleft palate patients and 10 complete cleft palate patients who got the operation in our hospital. And, the controls were 10 normal person. The sentence patterns using in this study were simple 5 vowels. Using CSL program we evaluated the Formant, Bandwidth. We analized the spectral characteristics of speech signals of 3 groups, before and after the operation. In most cases, the formant scores were higher in experimental groups (complete cleft palate group and submucosal type cleft palate group) than controls. There were small differences when speeching /a/, /i/, /e/ between experimental groups and control groups, large differences when speeching /o/, /u/. After surgery the formant scores were decreased in experimental groups (complete cleft palate group and submucosal type cleft palate group). In bandwidth scores, there were no significant differences between experimental groups and controls.
The purpose of the present study was to investigate the characteristics of receptive and expressive language development of cleft palate infants aged under 3. Twenty-six cleft palate infants and 52 normal infants were grouped into 3 chronological age groups with 1 year intervals: less than 1, 1, and 2 years old. The cleft palate infants were divided into 2 groups: cleft palate only, and cleft lip & palate. Each mother of the infants was asked to complete the questionnaire, Sequenced Language Scale for Infants (SELSI). Receptive and Expressive language scores of SELSI were computed. The scores of receptive and expressive language were respectively analyzed into 4 categories of language: phonology/prosody, semantics, syntax, and pragmatics. The results, concerning the differences of language development between the cleft palate and the normal infants, were as follows: (1) expressive language scores were significantly different at age 2 between the cleft palate and the normal infants; (2) cleft plate groups aged less than 1 and 1 showed lower scores of phonology/prosody of expressive language than the normal groups; (3) cleft palate group aged 2 showed lower scores than the normal group in semantics, syntax, and pragmatics. The results, concerning the characteristics of language development between the cleft palate only and the cleft lip & palate infants, were as follows: (1) the scores of expressive and receptive language were not statistically different between the 2 groups; (2) both groups did not show any difference in .the scores of phonology/ prosody, semantics, syntax, and pragmatics of receptive and expressive language.
A comparative study was undertaken to investigate the collapse of maxillary dental arch and palate in unilateral cleft lip and palate individuals. The material for this study consisted of 39 subjects with repaired unilateral cleft lip and palate (30 males, 9 females). The measurements of unilateral cleft lip and palate individuals were compared with the measurements of normal individuals (30 males, 30 females). All the subjects were in the mixed dentition stage and the mean age was almost the same. The following conclusions were obtained. 1. A large number of the maxillary dental arch of the unilateral cleft lip and palate individuals showed ${\Omega}$-shape, and the arch length was shorter than that of normal individuals. The intermolar width did not show significant difference between cleft group and group, but the intercanine width was mcuh smaller than that of normal individuals. 2. The palate of the unilateral cleft lip and palate subjects showed shorter and shallower form than that of normal subjects. 3. The palatal area of the unilateral cleft lip and palate subjects was smaller than that of normal subjects, and the cleft side area was much smaller than the opposing side area. 4. There was no significant sexual difference in measurements of maxillary dental arch and palate of the unilateral cleft lip and palate subjects.
Cleft Palate speech appears to have hyper/hyponasality with velopharyngeal insufficiency and articulation disorders. Previous studies on Cleft Palate speech have shown that speech tends to have lower airflow and air pressure. To examine the aerodynamic characteristics of Cleft Palate speech, Aerophone II Voice function Analyzer was used. We measured sound pressure level, airflow, air pressure and glottal power. Three Cleft Palate adults and five normal adults participated in this experiment. The test words are composed of: (1) the sustained vowel /o/ (2) /CiCi/, where C is one of three different stop consonants in Korean (3) /bimi/. Subjects were asked to produce /bimi/ five times without opening their lips. All the data was statistically tested by t-test for Cleft Palate patients before operation groups and control groups and paired t-test for Cleft Palate patients before and after operation groups. The results were as follow: (1) Cleft Palate patients generally speak with incomplete oral closure and lower oral air pressure. As a result, the SPL of Cleft Palate before operation is 3 dB lower than control groups. (2) Airflow of Cleft Palate in phonation and articulation is lower than that of control groups. However, it increased after operation. Lung volume and mean airflow in phonation are significantly increased (p<0.05). (3) Although velopharyngeal function (velar opening rate) of Cleft Palate is poor in comparison with control groups, it was recovered after operation. In this event maximum flow rate and mean airflow rate are significantly increased (p<0.05). (4) Air pressure of Cleft Palate in speech is lower than that of control groups. In general, the air pressure of Cleft Palate increased after operation. In this event air pressure of glottalized consonant is significantly increased (p<0.04). (5) Glottal Power(mean power, mean efficient and mean resistant) of Cleft Palate patients is lower than that of control groups. But mean efficient and mean resistant of Cleft Palate patients increased significantly (p<0.05) after operation.
Cleft lip and palate is a congenital deformity which needs a professional and consistent management from the birth and along with the physical growth of patients. The patients with cleft lip and palate can have general speech problems with resonance disorders, voice disorders and articulation disorders after the successful primary surgical management and the physical growth. Speech problems of Cleft lip and palate are characterized hypernasality, nasal air emission, increased nasal air flow, and aberrant speech marks which decrease intelligibility. These speech problems of cleft lip and palate can be treated with the secondary surgical procedure, the application of temporary prosthesis and the effective and well-timed speech therapy. The speech and language problems of cleft lip and palate, the general procedures and schedules of the speech assessment and therapy based on the multidisciplinary approach are introduced for the patients with cleft lip and palate, their family and the other members of the cleft palate treatment team.
Background: Nasalance is used to evaluate the velopharyngeal incompetence in clinical diagnoses using a nasometer. The aim of this study is to find the nasalance differences between Vietnamese cleft palate children and Korean cleft palate children by measuring the nasalance of five oral vowels. Methods: Ten Vietnamese cleft palate children after surgery, three Vietnamese children for the control group, and ten Korean cleft palate children after surgery with the same age participated in this experimentation. Instead of Korean control, the standard value of Korean version of the simplified nasometric assessment procedures (kSNAP) was used. Result: The results are as follows: (1) the highest nasalance score among the Vietnamese normal vowels is the low vowel /a/; however, that of Korean normal vowels is the high vowel /i/. (2) The average nasalance score of Korean cleft palate vowels is 18% higher than that of Vietnamese cleft palate vowels. There was a nasalance score of over 45% among the vowels /e/ and /i/ in Vietnamese cleft palate patients and /i/, /o/, and /u/ in Korean cleft palate patients. Conclusion: These different nasalance scores of the same vowels seem to cause an ethnic difference between Vietnamese and Korean cleft palate children.
The present study was aimed to evaluate the incidence, etiological factors, and management of cleft lip and palate. Two hundred and twenty patients with cleft lip and/or cleft palate who were treated at Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital, during the period between January 1994 and December 2003 were reviewed. The ratios of cleft lip : cleft lip with cleft palate : and cleft palate were 0.4:1.1:1. Males were more common than females in cleft lip (1.3:1) and cleft lip and palate (2.5:1), while females were more common than males in cleft palate (1:1.3). In the cleft side, left clefts were more prevalent than right clefts (cleft lip 1.3:1, cleft lip and palate 1.6:1). Unilateral clefts were more common than bilateral clefts in cleft lip (79:21). Cleft lip and cleft palate were more common in those with blood type A (34.5%) than those with other types. There was no significant relationship between birth season and frequency of clefts. The clefts were common in the first-born (48.8%), and in mothers aged between 25 and 29 (51.7%). Medication (24.7%) and stress (16.7%) during the first trimester were noted. Positive familial history was noted in 13 cases (5.9%). Thirty-two cases (15%) were associated with other congenital anomalies, in which tonguetie (40.6%) and congenital heart disease (21.9%) were most common. Among 100 patients with cleft palate, 77 patients had middle ear disease (77%), which occurred predominently in the incomplete cleft palate. Seventy-six among the 77 patients received myringotomy and ventilation tube insertion, and the remaining one received antibiotic medication only. Cleft lips were treated primarily at 3 to 6 months, and cleft palates were at 1 to 2 years. Treatment regimens included modified Millard method mainly in the cleft lip, and Wardill V-Y, Dorrance method, and Furlow method in the cleft palate. The percentage of palatal lengthening as type of cleft palate was greater in the incomplete cleft palate group (11.2%) than in the complete cleft palate group (9.6%). The percentage of palatal lengthening as operating method was no difference between the Furlow method (10.9%) and the push back method (10.7%). As postoperative complications, hypertrophic scar was most frequent in the cleft lip, and oronasal fistula in the cleft palate. In summary, it was shown that medication and stress during the first trimester of pregnancy were frequently associated with cleft lip and cleft palate, adequate timing and selection of method of operation are important factors to obtain morphologically and functionally good results. Furthermore prevention and treatment of middle ear disease are important in cleft palate patients because of its high co-occurrence.
A cephalometric study was performed to reveal differences between skeletal Class III malocclusion patients and cleft lip and palate patients, The material for this study consisted of 16 males (mean age 19.8, range 17-29) and 9 females(mean age 19.4, range 16-27) with cleft lip and palate, and 222 Skeletal Class III malocclusion patients(males 106, females 116), Cephalometric tracing and measurements were done by one investigator. Results were followed: 1. Cleft lip and palate group had more retrusive maxilla than the skeletal Class III malocclusion group. 2, Cleft lip and palate group had smaller effective maxillary and mandibular length than skeletal Class III malocclusion group, and the difference was more prominent in the mandible than in the maxilla. 3. Dental compensation was not observed in the upper incisors of cleft lip and palate group and in the lower incisors it was smaller than skeletal Class III group. 4, In the Gonial angle and lower anterior facial height values, there was no significant difference between cleft lip and palate and skeletal Class III malocclusion group. These results can be used in orthodontic treatment planning and orthognathic surgery for the cleft lip and palate patients.
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