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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2011  |  Volume : 29  |  Issue : 1  |  Page : 71-73
 

Feeding obturator appliance for an infant with cleft lip and palate


1 Department of Pedodontics and Preventive Dentistry, Subharti Dental College, Meerut, Uttar Pradesh, India
2 Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, India

Date of Web Publication23-Apr-2011

Correspondence Address:
P Chandna
Department of Pedodontics and Preventive Dentistry, Subharti Dental College, NH- 58, Delhi-Haridwar Bypass, Meerut, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.79950

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   Abstract 

Clefts of the palate, alveolus and lip are some of the most frequently encountered anomalies of the face. 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 11-day-old infant with a bilateral cleft lip and palate.


Keywords: Cleft lip, cleft palate, feeding obturator


How to cite this article:
Chandna P, Adlakha V K, Singh N. Feeding obturator appliance for an infant with cleft lip and palate. J Indian Soc Pedod Prev Dent 2011;29:71-3

How to cite this URL:
Chandna P, Adlakha V K, Singh N. Feeding obturator appliance for an infant with cleft lip and palate. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2019 Sep 22];29:71-3. Available from: http://www.jisppd.com/text.asp?2011/29/1/71/79950



   Introduction Top


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 syndrome. Non-syndromic clefts are of polygenic/multifactorial inheritance.

Pediatric dentists alone cannot resolve the multiple problems associated with cleft lip and palate. Hence, a cleft palate team was formed to treat the infant mentioned in this case study. The team included dentists (pediatric dentist, orthodontist, oral surgeon, and prosthodontist), plastic surgeon, pediatrician, otolaryngologist, psychologist, and a speech therapist who coordinated effectively to achieve the best treatment of the fundamental needs of the patient.

Neonates with cleft palate have difficulty in feeding, which may lead to failure to thrive. [2] A feeding obturator is a prosthetic aid that is designed to obturate 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. The article demonstrates the indications, construction, and benefits of a palatal obturator appliance in patients with a cleft lip and palate.


   Case Report Top


An 11-day-old healthy neonate (weight: 3,145 g) presenting with a cleft lip and palate and resultant poor feeding ability was referred to the Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana. The medical history of the child and parents was non-contributory. Extra-oral and intra-oral examination of the child [Figure 1] revealed a bilateral cleft lip and palate (Veau classification, Class IV). Since the child was not scheduled for cleft repair surgery in the near future, it was decided that a feeding obturator with low-density polyethylene material be constructed for the child.
Figure 1: Extra-oral view of bilateral cleft lip and palate

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Technique

A preliminary impression of the maxillary arch was made with polyvinyl siloxane putty material [Figure 2] and [Figure 3]. The infant was held with his face towards the floor in order to avoid aspiration. Also, it was noted that the infant was crying during the impression-making procedure. This thus ensured a patent airway continuously throughout the procedure.
Figure 2: Impression of cleft palate being made

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Figure 3: Final impression of the cleft palate

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The impressions were poured in a Type V dental stone [Figure 4]. The cast was inspected for any significant undercuts in the cleft area, which, if present, were blocked with wax. The vacuum tray was fabricated in a vacuum former machine (UltraVac Vacuum Former, Ultradent Products, Inc.) using a sheet of low-density polyethylene [Figure 5]. The stone cast was rested in a flat position on the vacuum former. The polyethylene tray material was allowed to sag only 1/2 to 1 inch. The vacuum motor was then run for 30-60 seconds. Following adaptation of the polyethylene sheet to the cast, tight adaptation along the palate and ridges was checked. The tray was then trimmed to remove excess material.
Figure 4: Stone model of the cleft impression

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Figure 5: Fabrication of vacuum tray in vacuum former

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An 8-inch floss was then attached to the feeding obturator to provide a safety mechanism in case of gagging or accidental swallowing. The appliance was positioned in the patient's mouth [Figure 6] and parents were instructed about placement and removal of the feeding obturator and its cleaning. Thereafter, the mother was asked to feed the infant. It was seen that the child was successfully able to feed with the feeding obturator appliance in place.
Figure 6: Feeding obturator in place

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   Discussion Top


Neonatal feeding obturator appliance is traditionally fabricated of acrylic resin that serves the following purposes: [2],[3],[4],[5],[6],[7]

  • Creates a rigid platform, towards which the child can press the nipple and feed
  • Reduces nasal regurgitation
  • Reduces the time required for feeding
  • Helps position the tongue away from the cleft area in the correct position to allow spontaneous growth of palatal shelves towards each other
  • Reduces parents' frustration as a result of feeding problems.


Apart from the above-mentioned benefits, the vacuum tray was chosen over an acrylic obturator because of its added advantages of being light weight, moldability, and good fit to palate and ridges and decreased possibility of soft tissue injury because of its soft texture.

A variety of impression materials such as alginate, [4],[6] low fusing compound, [8] polysulfide impression material [9] may be used to make a definitive impression. In the present case, a putty-type polyvinyl siloxane was used to make the impression because its high viscosity reduces the danger of aspiration or swallowing. Moreover, the relatively good detail duplication is satisfactory for the purpose of fabricating a palatal prosthesis. [2]

The infant was held with his face towards the floor in order to prevent aspiration in the event of vomiting and also asphyxiation due to airway obstruction. It was also ensured that the infant made sucking motions during impression-making as this helps ensure better moldability.

 
   References Top

1.McDonald R, Avery D, Dean J. Dentistry for the Child and the Adolescent. 8 th Ed St. Louis, Missouri: Mosby; 2004.  Back to cited text no. 1
    
2.Goldberg WB, Ferguson FS, Miles RJ. Successful use of a feeding obturator for an infant with a cleft palate. Spec Care Dentist 1988;8:86-9.  Back to cited text no. 2
[PUBMED]    
3.Savion I, Huband ML. A feeding obturator for a preterm baby with Pierre Robin sequence. J Prosthet Dent 2005;93:197-200.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Osuji OO. Preparation of feeding obturators for infants with cleft lip and palate. J Clin Pediatr Dent 1995;19:211-4.  Back to cited text no. 4
[PUBMED]    
5.Samant A. A one-visit obturator technique for infants with cleft palate. J Oral Maxillofac Surg 1989;47:539-40.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Oliver HT. Construction of orthodontic appliances for the treatment of newborn infants with clefts of the lip and palate. Am J Orthod 1969;56:468-73.  Back to cited text no. 6
[PUBMED]    
7.Turner L, Jacobsen C, Humenczuk M, Singhal VK, Moore D, Bell H. The effects of lactation education and a prosthetic obturator appliance on feeding efficiency in infants with cleft lip and palate. Cleft Palate Craniofac J 2001;38:519-24.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Muthu MS. Management of an infant with cleft lip and palate with phocomelia in dental practice. J Indian Soc Pedod Prev Dent 2000;18:141-3.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.Saunders ID, Geary L, Fleming P, Gregg TA. A simplified feeding appliance for the infant with cleft lip and palate. Quintessence Int 1989;20:907-10.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


This article has been cited by
1 Diagnosis and Management of Patients with Clefts
Larry D. Hartzell,Lauren A. Kilpatrick
Otolaryngologic Clinics of North America. 2014; 47(5): 821
[Pubmed] | [DOI]
2 Simplified design and precautionary measures in fabrication of a feeding obturator for a newborn with cleft lip and palate
Dubey, A. and Mujoo, S. and Khandelwal, V. and Nayak, P.A.
BMJ Case Reports. 2013;
[Pubmed]



 

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