Feeding Appliance

264Pakistan Oral & Dental Journal Vol 32, No. 2 (August 2012)

Feeding appliance for an infant with cleft lip and palate

CASE REPORT

1 Senior Lecturer, Department of Pedodontics2 Professor & Head, Department of PedodonticsFor Correspondence: Dr Pooja Malik, 40-Chanakya Puri, Near F-Block Shastrinagar, Meerut-250004,e-mail: [email protected], [email protected]

INTRODUCTION

Clefts of lip and palate are the most commoncongenital deformities involving the orofacial region.1

Incidence of 0.28-3.74 per 1,000 live births.2 Cleft lipcan be defined as the presence of one or two verticalfissures in the upper lip and cleft palate is defined as afurrow in the palatal vault.3

There are numerous problems associated withindividuals with a cleft lip or palate, which affects thefunctions performed by the oral and nasal cavities.4

The oro-nasal communication diminishes the ability tocreate negative pressure which is necessary for suck-ling.5-8 The feeding process is also complicated by nasalregurgitation of food,5,7,10 excessive air intake thatrequires frequent burping and choking.7 Feeding timeis significantly longer and fatigues both baby as well asmother.5,7,9,10

The feeding plate obturates the cleft and restoresthe separation between oral and nasal cavities. Itcreates a rigid platform towards which the baby canpress the nipple and extract the milk.5 It facilitatesfeeding,4,7 reduces nasal regurgitation,6,7 reduces theincidence of choking and shortens the length of timerequired for feeding.5,7 The obturator also prevents thetongue from entering the defect5,7 and interfering withthe spontaneous growth of palatal shelves towards the

midline. It also helps to position the tongue in correctposition to perform its functional role in the develop-ment of jaws, and contributes to speech development.Feeding plate restores the basic functions of mastica-tion, deglutition and speech production until the cleftlip and/or palate can be surgically corrected.

This article presents a case report of an infant withcleft lip and palate to whom feeding appliance wasdelivered.

CASE REPORT

A four month old infant was brought to the Depart-ment of Pedodontics and Preventive Dentistry, KalkaDental College, Meerut with the chief complaint ofdifficulty in feeding. On examination, it was found thatchild was born with unilateral cleft lip and palate onright side (Fig 1) After complete examination of thepatient it was decided to fabricate feeding plate for thepatient, so that it reduce feeding problem.

Preliminary Impression of the maxillary arch wasmade with polyvinyl siloxane putty material (Fig 2).The infant was held upright by mother to preventaspiration of any extra material. The tray was seateduntil the impression material adequately covered theanatomy of the upper gum pads. Once the impressionmaterial was set, the tray was removed, and the mouth

FEEDING APPLIANCE FOR AN INFANT WITH CLEFTLIP AND PALATE

1POOJA MALIK2ABHAY AGARWAL

1RAVISH AHUJA

ABSTRACT

Clefts of lip and palate are the most common congenital deformities involving the orofacial region.One of the immediate problems to be addressed in newborn is difficulty in feeding. Here, we presenta case of 4month old infant with unilateral cleft lip and palate for whom feeding appliance was made.

Key words: Cleft lip, cleft palate, feeding appliance



was examined for residual impression material. Theimpression was then poured with dental stone to obtainan accurate cast.

The feeding plate was fabricated on the dentalstone model. All the undercuts and the cleft space wereblocked with wax. The plate was made up of hard self-cure acrylic lined by soft denture material in the centre

(fig 3). Floss was attached to the feeding appliancebecause it prevents swallowing and easy retrieval ofappliance. Finally, appliance was placed in childs oralcavity and child was fed (fig 4).

Parents were instructed to keep the plate in for fulltime, and take out for cleaning at least once in a day.Initially it may take longer to feed the child with plateand even it is uncomfortable for the child, gradually itshould be adjusted.

DISCUSSION

Feeding appliance restores palatal cleft and aid increating sufficient negative pressure which allowsadequate sucking of milk. It helps child to compress thenipple easily because it provides a contact point andhelps the infant to express milk. It facilitates feeding,reduces nasal regurgitation.10,11

A comprehensive management of children bornwith cleft lip and palate is best accomplished by themultidisciplinary team approach. Dentist plays an im-portant role in the team which is working closely withmedical and allied health specialties. However, promptintervention by fabrication of feeding plate caneliminate the immediate problems i.e. proper nourish-ment and prevention of infections for the alreadydebilitated infant.12 Inadequate nourishment due todifficulty in feeding affects the health and acts as astumbling block in the milestone of normal develop-ment.13

REFERENCES

1. Profit WR, Fields HW, Sarver DM. Contemporary Ortho-dontics. 4th ed india: Mosby (an imprint of Elsevier) 007,p.287-88.

Fig 1: Unilateral cleft lip and palate (pre-operative)

Fig 2: Preliminary impression with putty material

Fig 3: Final cast with appliance

Fig 4: Feeding appliance placed in the oral cavity



2 Singh G. Text book of Orthodontics. 1st ed. India: Jaypee:004.p.629-44.

3 Ravichandra KS, Vijayaprasad KE, Vasa AAK, Suzan S.A new technique of impression making for an obtura-tor in cleft lip and palate patient. JISPPD, 2010; 8(4);311-14.

4 Osuji OO. Preparation of feeding obturators for infantswith cleft lip and palate. J Clin Pediatr Dent 1995;19:211-14.

5 Samant A. A one-visit obturator technique for infants withcleft palate. J Oral Maxillofac Surg 1989;47:539-40.

6 Jones JE, Henderson L, Avery DR. Use of a feeding obturatorfor infants with severe cleft lip and palate. Spec Care Dentist1982;2:116-20.

7 Choi BH, Kleinheinz J, Joos U, Komposch G. Suckingefficiency of early orthopaedic plate and teats in infantswith cleft lip and palate. Int J Oral Maxillofac Surg 1991;20:167-69.

8 Shprintzen RJ. The implications of the diagnosis of Robinsequence. Cleft Palate Craniofac J 1992;29:205-09.

9 Saunders ID, Geary L, Fleming P, Gregg TA. A simplifiedfeeding appliance for the infant with cleft lip and palate.Quintessence Int 1989;20:907-10.

10 Jones JE, Henderson L, Avery DR. Use of a feeding obturatorfor infants with severe cleft lip and palate. Spec Care Dentist1982;2:116-20.

11 Saunders ID, Geary I, Flemming P, Gregg TA. A simplifiedfeeding appliance for infant with cleft lip and palate.Quintesscence Int 1989;20:907-10.

12 M. Rathee, A. Hooda, A.K. Tamarkar, S.P.S. Yadav: Role ofFeeding Plate in Cleft Palate: Case Report and Review ofLiterature. The Internet Journal of Otorhinolaryngology.2010 Volume 12 Number 1.

13 Agarwal A, Rana V, Shafi S. A feeding appliance for a new-born baby with cleft lip and palate. Natl J Maxillofac Surg2010;1:91-93.

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Feeding Appliance