Cleft Palate Case Studies

Abstract

Cleft lip and palate are the most common congenital maxillofacial anamalies. One of the problems to be addressed in such newborn is difficulty in feeding. Formation of a good seal around nipple can be difficult due to the incomplete formation of facial and palatal structures. Nasal regurgitation and choking are common in infants with cleft palate due to communication between the nasal and oral cavities. The case presented here is a 3-day-old neonate born with cleft lip and palate, assisted with a new feeding appliance for proper feeding.

Key words: cleft lip, cleft palate, feeding appliance

Introduction

Clefts of lip and palate are the most common congenital deformities involving the orofacial region.1 Incidence of Clefts of lip

On examination, it was found that the child was born with unilateral cleft lip and palate on right side (Figure 1). After discussion with the parents, it was found that there was difficulty in feeding the newborn; hence, a feeding appliance was planned for reducing the feeding problem. A preliminary impression of maxilla was made with use of an impression compound. A cast was then poured on the impression and custom tray was fabricated. Secondary impression was then made using rubber base impression material (puttytype polyvinyl siloxane) (Figure 2). The infant was held in prone position by mother to prevent aspiration of any extra material. The impression was then poured to obtain final cast. A feeding appliance was then fibricated on the final cast by using ethylene vinyl acetate (Figure 3). Ethylene vinyl acetate is available in market as bioplast®. The feeding appliance was placed in the oral cavity of the newborn and child was easily fed with the help of the appliance (Figure 4 and 5). Parents were instructed to keep the plate in for full time and cleaning should be done at least once in a

Treatment of this deformity presents a serious problem all over the world. Difficulty in sucking is one of the most common complaint related with cleft lip and palate infants.9 For normal sucking mechanism, coordination of the intraoral and extraoral muscles is important, but such coordination is difficult in infants with cleft lip and palate. So, breast feeding in such infants is a challenging task.10 The opening in the palate makes it impossible for the child to create suction and causes difficulty in feeding. Similar problem was observed in present case.

Based on the severity of the cleft, the amount of difficulty in feeding may vary. For successful breast feeding, the mother needs to implement a position which can minimize nasal regurgitation (child in usually held at an angle of 45 during feeding). There are a variety of feeding devices that can be useful for feeding an infant with a cleft lip and palate like a soft nipple, plastic squeeze bottle, specially designed nipple with modifications. One of such device is an intraoral maxillary obturator which has proved beneficial by providing the feeding