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CASE REPORT
Year : 2012  |  Volume : 30  |  Issue : 4  |  Page : 352-355
 

Fabricating feeding plate in CLP infants with two different material: A series of case report


1 Department of Prosthodontics, HP Government Dental College, Shimla, India
2 Department of Pedodontics and Preventive Dentistry, HP Government Dental College, Shimla, India
3 Private Dental Practitioner, Shimla, Himachal Pradesh, India
4 Department of Oral Pathology and Microbiology, HP Government Dental College, Shimla, India

Date of Web Publication19-Mar-2013

Correspondence Address:
R Gupta
Department Of Prosthodontics, HP Government Dental College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.108943

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   Abstract 

Feeding is a family's biggest concerns when a child is born with cleft lip and/or palate. The goal for that child is to have as near normal feeding as possible. This report presents fabrication of feeding plates in two infants born with cleft lip and palate using two different materials.


Keywords: Autopolymerizing acrylic, CLP, feeding plate, thermoplastic sheet


How to cite this article:
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

How to cite this URL:
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 [serial online] 2012 [cited 2019 Dec 13];30:352-5. Available from: http://www.jisppd.com/text.asp?2012/30/4/352/108943



   Introduction Top


Orofacial clefts are congenital deformities that manifest at birth causing difficulty in breathing and feeding. The severity depends on extent of involvement that can include lip, alveolar ridge, hard palate and soft palate. [1] Clefts of the lip and palate are the most common congenital deformities involving the orofacial region. Overall incidence of cleft lip and palate is 1:700 in live human births. Etiology could be either hereditary or environmental. Genetically, defects are male sex-linked recessive. Environmental factors that influence in the first trimester of pregnancy are viral infections, exposure to radiations and influence of drugs like excessive use of antibiotics, steroids, insulin, and antiepileptic drug. Other factors include deficiency of vitamin A and B, anemia, and anorexia. [1] These clefts 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. [2] Feeding the cleft lip and palate infant poses challenges to the parents. As there is abnormal oronasal communication in these patients. [3] These infants often have difficulty closing their mouth around the nipple of the mother or the bottle to make a seal. In addition these infants may have excessive air intake, nasal regurgitation, and choking.

A feeding appliance may be a favorable option for babies that are having feeding problems. The feeding appliance functions as an obturator in the cleft area. The feeding appliance obturates the cleft and creates a platform toward which the baby can press the nipple and extract milk. [4] The present case report shows prosthodontic management of two cases of CLP by fabricating feeding obturator using two different materials.


   Case Report Top


Two infants (2-day old, case-l and 1-month old, case-ll) with CLP were referred from Department of Pediatrics of Indira Gandhi Medical College, shimla to our department for prosthetic management at different times as they were to be operated after few months. On examination both infants were found to be of same classification i.e., Vaeu's-3 [Figure 1] and [Figure 2]. After consulting with the respective parents it was decided to fabricate feeding appliances for both the cases. The patient along with one of the parents was seated facing forwardly in the dental chair. The elastomeric impression was taken in custom made impression tray making sure that patient did not choke [Figure 3] and [Figure 4]. The impressions were poured and casts retrieved [Figure 5], [Figure 6], [Figure 7] and [Figure 8] after blocking the undercuts.
Figure 1: Case 1 -The defect and feeding tube

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Figure 2: Case 2-The defect

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Figure 3: Case 1 -Impression making

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Figure 4: Case 2 -Impression making

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Figure 5: Case 1- Impression in putty

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Figure 6: Case 1-Cast showing the defect

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Figure 7: Case 2 - Elastomeric impression

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Figure 8: Case2 -Cast showing the defect

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On the Case-l cast the thermoplastic resin sheet was adapted using thermal vacuum machine [Figure 9] and [Figure 10]. The excess portions were trimmed and nylon thread was attached [Figure 11].
Figure 9: Thermoplastic resin sheet for case 1

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Figure 10: Thermal vacuum machine for case 1

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Figure 11: Case 1 -Appliance with nylon thread

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On the Case-ll cast, separating media was applied. Using autopolymerizing acrylic resin the obturator was fabricated following sprinkle on method of polymerisation. The nylon thread was attached to appliance during polymerisation [Figure 12]. During the delivery of the appliance, it was made sure that the borders were smooth and not overextended and it did not block the airway passage. Immediately after delivering the appliances, mothers successfully fed the babies. After giving the instructions, they were told to have a follow-up appointment after a week for adjustments if any. Approximately after 3 months of use, both the cases reported back with loose appliances which were then replaced by the newer ones.
Figure 12: Case 2 - Appliance in self-cure acrylic

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   Discussion Top


Prosthetic fabrication of feeding obturator becomes must in CLP babies considering the health of the infant because surgical treatment usually starts at 2-3 months of age. Prosthodontic management in a CLP infant poses a great challenge due to lack of cooperation from the patient and the inadequate size of oral cavity. So every care must be taken while taking the impression till the delivery of the appliance. There is very little in the literature regarding comparison of materials used for making feeding plates in CLP patients. In this case report, two different materials (thermoplastic resin sheets, EVAand autopolymerising acrylic resin) were used and analysed, to fabricate feeding obturators in two different CLP infants. Both materials have pros and cons. EVA obturators were smooth and soft so there were minimal chances of patient injury. But on the other hand, these obturators did not provide rigid platform for suckling which is desirable. Although obturators made in self-cure acrylic are not soft in nature, can harm the patient but these provide rigid platform necessary for suckling. Moreover these obturators are less expensive than EVA obturators.

Palatal obturation improves palatal seal in many patients and so may improve the generation of negative pressure but these obturators are potentially dangerous if partially swallowed regardless of the material from which it has been made. [5]


   Conclusions Top


Feeding appliances bridge the gap which exists between a malnourished and an adequately nourished CLP newborn.

 
   References Top

1.Shahapur S, Talikoti A, Basutkar N. Prosthetic Management of Nasoalveolar Clefts in Newborns: A series of case report. J Indian Prosthodont Soc 2011;11:250-3.  Back to cited text no. 1
    
2.Reid J. A review of feeding intervention for infants with cleft palate. Cleft palate craniofac. J 2004;41:268-78.  Back to cited text no. 2
[PUBMED]    
3.Suji O. Preparation of feeding obturator for infant with cleft lip and palate. J Clin Pediatr Dent 1995;19:211-4.  Back to cited text no. 3
    
4.Agarwal A, Rana V, Shafi S. A feeding appliance for a newborn baby with cleft lip and palate. Natl J Maxillofac Surg 2010;1:91-3.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Clarren SK, Anderson B, Wolf LS. Feeding infants with cleft lip, cleft palate, or cleft lip and palate. Cleft Palate J 1987;24:244-9.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusions
    References
    Article Figures

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