In cleft palate patient, characteristic of speech disorder is the resonance disorder result from velopharyngeal incompetence. Clinically VPI caused by congenital factor as congenital palatal incompetence, submucosal cleft palate, and caused by acquired factor as CNS damage, tumor, palatal palsy. The clinicians more concerned about the speech disorders after cleft palate surgery rather than language pathologist. The resonance disorder devided for hypernasality, hyponasality and nasal emission, but as a rule, hypernasality is typical phenomenon of the resonance disorder. Traditionally clinicians and language pathologists evaluated four-stage or five-stage of hypernasality by subjective assessment. Although language pathologist is well-trained, results of the language level should be different. In late 1980s, Kay Elemetrics Corp. developed nasometer that objective nasalance identified with well-trained language pathologist and originate from nasometer Tonar I and II were developed by Fletcher. Therefore objective nasalance test was possible, the nasometer used in hospital, collage and speech clinic both and home and abroad. Standardization of the cleft palate speech assessment must be settled without delay because of different character result in different language and different assessment results by dialect in same language. In our study, we provide the data base for the standardization of cleft palate speech assessment which through report of objective assessment method, speech therapy effects and problems result in interdisciplinary teamwork by nasometer use in treatment of cleft palate patient.

Velopharyngeal insufficiency(VPI), characterized by hypernasal resonance and nasal air emission, is a speech disorder that can significantly compromise speech intelligibility. Cleft palate, previously repaired cleft palate and submucous cleft palate are associated with VPI. Less commonly, patients may acquire it after adenoidectomy with or without tonsillectomy or as a result of neuromuscular dysfunction. Comprehensive evaluation by a VPI team includes medical assessment focusing on airway obstructive symptoms, perceptual speech analysis, MRI and instrumental assessment. Options for intervention include speech therapy, intraoral prosthetic devices and surgery. Surgical methods can be categorized as palatal, palatopharyngeal or pharyngeal procedures. Each surgical approach has its strengths and limitations. Oro-maxillofacial surgeons are increasingly involved in the referral, evaluation, and treatment of velopharyngeal function. Therefore, understanding of physiology, anatomic structures, evaluation and treatment protocols in VPI is very important. This article presents protocol for evaluation of velopharyngeal function with a focus on indications for surgical interventions.

From 2001 year, our department has been participated medical charity for cleft lip and palate patients with Japanese team, on general hospital of Quang Nam Province in Tamky, Vietnam. Also we started medical service with student volunteer in Hue University Hospital, sisterhood relationship with Chonbuk National University, from 2006. The central area of Vietnam is a hard fought-field during the Vietnam war, many chemical weapons (defoliant etc.) were used during war. As the mountain region lose currency, this area was still retarded. We would like to introduce the medical charity service of our department and the classification of operated patients and performed operation.

The variations of cleft lip deformities imposed the difficulty to the surgical correction for them. Straight line technique for cleft lip surgery has been ignored quite long since other techniques were developed. Initially the straight line technique was introduced and widely accepted because it is simple and easy to perform during the period of no adequate anesthetics. But it was abandoned for its several shortcomings such as tighten lip, vermilion notching, anatomical distortion, and wound contractures. Recently, some groups advocated the usefulness of straight line technique which has a significant modification from its original form. Additionally the variable degree of cleft lip deformity allows simple straight line closure for those patients. Here a case of simple straight line technique was presented and discussed for its reliability and plausible results as well.

Cleft lip and palate patients often develop maxillary retrusion due to the combined effects of the congenital deformity and the scar tissue after surgical repairs. Maxillary protraction in the cleft patients using orthopedic appliances (i.e. face mask) or distraction osteogenesis during early childhood helps to achieve more balanced skeletal harmony and favorable occlusion for future growth to occur. Kinds, indication, protocol for use of the traditional orthopedic appliances will be discussed. Also the facemask with miniplate system recently developed will be introduced.