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ABSTRACT : Cleft lip and cleft palate is a commonly observed congenital maxillofacial defect. The cleft
palate is associated with feeding difficulties, eustachian tube dysfunction, middle ear effusions, middle ear
infections, hearing loss, speech disorders, dental and orthodontic problems. Feeding plate is a prosthetic
aid that is designed to seal the cleft and restore the separation between oral and nasal cavities. This article
presents a case report of a neonate with cleft lip and palate in whom a feeding obturator was delivered. This
article demonstrates the indications, construction, and benefits of a palatal obturator in an -old infant.
1Dr Abhinav Gupta,
Department of Prosthodontics Crown and Bridge Dr Z.A. Dental College
Aligarh Muslim University, Aligarh
2Dr Shakeba Quadri
INTRODUCTION : Cleft lip and palate is one of the most
common craniofacial anomalies in humans, with an incidence
of 0.28-3.74 per 1,000 live births.(1) Children born with a
cleft lip and palate encounter a number of problems that must
be solved for complete rehabilitation. Clefts of the palate,
alveolus and lip may be syndromic or non-syndromic. The
syndromic types are by definition associated with other
malformations, and include the Pierre Robin sequence,
Treacher Collins Malformation, trisomies 13 and 18, Apert's
syndrome, Stickler's syndrome, as well as Waardenburg's
s y n d r o m e . N o n - s y n d r o m i c c l e f t s a r e o f
polygenic/multifactorial inheritance. [2]
Cleft lip and palate affect several systems and functions that
include feeding, facial growth, dentition, mastication,
deglutition, speech as well as social and psychological
problems which have an impact on the child and parents.
Feeding the cleft lip and palate infant poses challenges to the
parents. As there is abnormal oronasal communication in
these patients. These infants often have difficulty closing their
mouth around the nipple of the mother or the bottle to make a
seal.[ 3] In addition these infants may have excessive air
intake, nasal regurgitation, and choking[. 3]
A feeding appliance may be a favourable option for babies
that are having feeding problems[.3]The feeding appliance
covers the cleft palate and creates a platform toward which the
baby can press the nipple and extract milk.[ 4]
It facilitates feeding,[5 ] reduces nasal regurgitation,[6,]
reduces the incidence of choking and shortens the length of
time required for feeding.[7] The obturator also prevents the
tongue from entering the defect[8] and interfering with the
spontaneous growth of palatal shelves towards the midline.
Restores the basic functions of mastication, deglutition and
speech production until the cleft lip and/or palate can be
surgically corrected. The procedure for fabrication of feeding
obturator is described. This article presents case reports of
two months old infant with cleft lip and palate in whom a
feeding appliance as obturator was delivered.
CASE REPORT : A 2month day old infant was brought to
the Department of Prosthodontics with the chief complaint of
difficulty in feeding. A 2 months old female infant presented
with a history of cleft palate associated with difficulty in
feeding, recurrent respiratory tract infection, nasal discharge
and recurrent ear infections(fig.1). The mother reported that
the baby is not able to suckle milk properly and she was not
gaining weight.
After complete examination of the patient, decision was made
to fabricate feeding plate to reduce feeding problem.
Preliminary Impression of the maxillary arch was made with
PROSTHETIC MANAGEMENT OF CLEFT PALATE : A CASE REPORT
Journal of Dental Sciences
University
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 102
University J Dent Scie 2017; No. 3, Vol. 2
CaseReport
Keywords-
Cleft lip, cleft palate,
feeding obturator
Source of support : Nil
Conflict of interest: None
polyvinyl siloxane putty material by using handle of no. 0
stock metallic perforated tray(fig.2). Gauze piece was placed
over the impression material to prevent impaction of material
in the cleft defect. The infant was held upright by mother to
prevent aspiration of any extra material. The tray was seated
until the impression material adequately covered the anatomy
of the upper gum pads. Once the impression material was set,
the tray was removed, and the mouth was examined for
residual impression material.
FABRICATION TECHNIQUE FOR FEEDING PLATE :
The impression was poured with dental stone to make master
cast and all the undercuts were blocked out using
clay(fig.3).Two wings were made using 21 gauge orthodontic
wire with tags at the end of wire components for stabilization
of prosthesis. Wings were stabilized on their position on the
cast using sticky wax. Feeding plate was fabricated using
autopolymerizing acrylic resin by finger adapted dough
method,and stabilized by elastics(fig. 4).
Finally, appliance was placed in infant's oral cavity.
Intraorally extensions of the prosthesis were proper covering
the entire defect(fig.5). Parents were instructed and taught
how to insert the plate in the oral cavity and how to feed the
infant(fig.6). Parents were asked to maintain the oral hygiene
of the infant and regarding cleaning of feeding plate.
Follow up and outcome: During one month follow up visit, we
have observed that:
Pre-operative weight: 3.1 kg, Postoperative weight: 3.6 kg
With the help of feeding appliance, significant improvement
in the nutritional status and health of child has been observed.
The adequate weight of babies has also increased after using
feeding plate obturator.
DISCUSSION- Feeding appliance restores palatal cleft and
aid in creating sufficient negative pressure which allows
adequate sucking of milk. It facilitates feeding, reduces nasal
regurgitation.(9 )A comprehensive management of children
born with cleft lip and palate is best accomplished by the
multidisciplinary team approach. Dentist plays an important
role in the team which is working closely with medical and
allied health specialties.
A major concern in treating these patients is obtaining good
impressions, which pose a unique set of challenges including
the size constraints imposed by the infant's oral cavity,
anatomical variations associated with the severity of cleft and
a lack of ability of the infant to cooperate and respond to
commands(.5) A number of positions have been adopted for
cleft palate impression making in infants, includes prone, face
down, upright, and even upside down.(10,11 )The impression
tray should be of adequate size to cover entire maxilla and
cleft palate defect. Prefabricated trays those are commercially
available for making impression of an infant with a cleft
palate. Ice cream sticks can also be used to carry impression
materials for infant impressions. The impression materials
can be supported with the fingers and placed in the patient's
mouth till the material completely sets.
Various impression materials like alginate, low fusing
impression compound and elastomeric (rubber base)
impression materials have been routinely employed for
making impression of neonate with CLP. Feeding obturator
can be prepared with various materials like acrylic resin,
visible light cured acrylic, acrylic polymer, silicones,vaccum
formed polyethylene.(1) Auto-polymerizing acrylic resin
material was chosen to fabricate feeding obturator as it is
easily available, cost effective, simple to fabricate, hygienic,
has good strength and can be fabricated with thin margin.
SUMMARY – This clinical report describes a method for the
fabrication of a feeding obturator for 2 days old neonate with
cleft lip and cleft palate , using hand for making primary
impression. Feeding the cleft lip and palate infant poses
challenges to the parents. Feeding obturator helps in
minimizing the feeding problems in cleft lip and palate
patients. It normalizes tongue position resulting in better
speech, aids in better esthetics, reduces feeding time, provides
positive psychological impact on the parents and promotes
neonatal weight gain which is important in preparing the baby
for corrective surgery.
Figure .1
Figure. 2
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 103
University J Dent Scie 2017; No. 3, Vol. 2
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Figure 4
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Figure 6
REFRENCES :
1 . McDonald R, Avery D, Dean J. Dentistry for the Child
and the Adolescent. 8 th Ed St. Louis, Missouri: Mosby;
2004.
2. Chandna P, Adlakha VK, Singh N. Feeding obturator
appliance for an infant with cleft lip and palate: J Indian
Soc Pedod Prev Dent 2011;29(1):352-5.
3. Gupta R, Singhal P, Mahajan K, Singhal A. Fabricating
feeding plate in CLP infants with two different material:
A series of case report. J Indian Soc Pedod Prev Dent
2012;30:352-5.
4. Sikligar S, Shah S, Mulchandani V, Rachappa MM, Dave
B. A ray of hope in cleft lip and palate patients: case
reports: European Journal of Dental Therapy and
Research 2014:3 (2):217-220.
5. Osuji OO. Preparation of feeding obturators for infants
with cleft lip and palate. J Clin Pediatr Dent 1995;19:
211-14.
6. Choi BH, Kleinheinz J, Joos U, Komposch G. Sucking
efficiency of early orthopaedic plate and teats in infants
with cleft lip and palate. Int J Oral Maxillofac Surg
1991;20.
7. Osuji OO. Preparation of feeding obturators for infants
with cleft lip and palate. J Clin Pediatr Dent 1995;19:
211-14.
8. Samant A. A one-visit obturator technique for infants
with cleft palate. J Oral Maxillofac Surg 1989;47:539-
40.
9. Choi BH, Kleinheinz J, Joos U, Komposch G. Sucking
efficiency of early orthopaedic plate and teats in infants
with cleft lip and palate. Int J Oral Maxillofac Surg. 1991
Jun;20(3):167–169.9.
10 Jacobson BN, Rosenstein SW. Early maxillary
orthopedics for the newborn cleft lip and palate patient:
An impression and an appliance. Angle Orthod
1984;54:247-63.
11. Grayson BH, Santiago PE, Brecht LE, Cutting CB.
Presurgical nasoalveolar molding in infants with cleft lip
and palate. Cleft Palate Craniofac J 1999;36:486-98.
CORRESPONDING AUTHOR-
Dr. Abhinav Gupta
Department of Prosthodontics Crown and Bridge
Dr. Ziauddin Ahmad Dental College
Aligarh Muslim university, Aligarh
UP India
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 104
University J Dent Scie 2017; No. 3, Vol. 2