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

Figure 3

Figure 4

Figure 5

Figure 6

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CORRESPONDING AUTHOR-

Dr. Abhinav Gupta

Department of Prosthodontics Crown and Bridge

Dr. Ziauddin Ahmad Dental College

Aligarh Muslim university, Aligarh

UP India

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University J Dent Scie 2017; No. 3, Vol. 2