Complex Care of Individuals with Cleft Lip and Cleft Palate or Velopharyngeal Insufficiency

The palate is a very small part of the human constitution, but it takes part in the undisturbed arrangement of several different functions. Its faulty or insufficient activity leads first of all to disorders of speech, hearing and swallowing. The competency of the pho-niatrician and speech therapist is therefore obvious in improving of these problems. The cooperation of the representatives of borderline disciplines, a complex teamwork is, however, indispensable in diagnostics, treatment and care of individuals with cleft lip and palate (CLP) and/or with other forms of velopharyngeal insufficiency (VPI). The present publication aims to demonstrate the importance of this interdisciplinary work. The Cleft Palate (CP) Committee of the International Association of Logopedics and Phoniatrics (IALP) wants to present in this issue – based on the invitation of the board of the association – the manifold aspects and details of VPI by means of excellent authors working in different areas of the topic and in very different parts of the world. The authors of the first article (Czeizel and Hirschberg) deal with the classification, epidemiology, and the genetics of orofacial clefts describing the possibilities of the prevention of the cleft on the basis of Hungarian investigations. Although prevention is better than surgery – as the above-mentioned authors write -it is obvious that full prophylaxis is nowadays only a promise of the future, therefore we must focus our attention on treatment, on achievement of therapeutic efforts as successful as possible. The prerequisite to good results are the exact diagnosis, the correct evaluation of symptoms and a complex, systematic follow-up and care of the CP/VPI individuals made by a multidisciplinary team. The next papers demonstrate this manifold work in the field of diagnostics and therapy. Kawano et al. summarize the Japanese experiences emphasizing the value of the combined use of nasopharyngofiberoscopy and fluorovideography especially in revealing slight velopharyngeal incompetence. Kotby et al. (Cairo) detail the problems of assessment of VPI in developing countries using three levels in the evaluation according to the different socioeconomic situations: the elementary diagnostic procedures, clinical diagnostic aids and additional instrumental measures. Van Demark (Iowa) summarizes the diagnostic value of the different articulation tests in assessment of and the speech therapeutic tasks with individuals having clefts.