Rehabilitation of a One-day-Old Neonate with Cleft Lip and Palate using Palatal Obturator: A Case Report

Early Intervention With Obturators: A Case Series of Infants With Cleft Palate

A cleft palate is a congenital anomaly that can significantly impact an infant's ability to feed and grow normally. This article presents a case series of three infants diagnosed with a congenital cleft palate, who were fitted with a custom obturator for feeding purposes. The infants exhibited difficulty with suction and oral feeding due to the cleft, which led to inadequate nutrition and increased risk of aspiration. To address this issue, a removable obturator was fabricated to temporarily occlude the palatal gap and improve the efficiency of sucking after taking consent for the same from the parents. The obturator was designed to ensure a secure fit, promote proper alignment, and reduce the risk of nasal regurgitation during feeding. The infants demonstrated immediate improvements in feeding and a significant reduction in aspiration risk. The article highlights the importance of early intervention and the role of prosthetic devices like obturators in managing feeding difficulties associated with cleft palate in neonates. Additionally, this report emphasizes the importance of a multidisciplinary approach involving pediatricians, speech therapists, and prosthodontists in the management of infants with cleft palate.

Effect of cleft palate type and manufacturing method on feeding plate adaptation: A volumetric micro-computed tomography analysis

PURPOSE

Feeding plates for cleft palate patients have been used by clinicians for many years to temporarily close the oro-nasal communication until definitive treatment with surgical techniques. The current in vitro study aimed to evaluate the adaptation of the feeding plates manufactured by two different techniques for three cleft types.

MATERIALS AND METHODS

Feeding plates were manufactured with conventional compression molding (CM) and 3-dimensional (3D) additive manufacturing on main models representing bilateral cleft, unilateral right, and unilateral left cleft types (n = 10). The 3D volumetric space between the feeding plate and the corresponding main model was measured by micro-CT to evaluate the adaptation. The adaptation of the plates was assessed based on three different measurement regions: anterior, left, and right. Repeated measure analysis of variance (ANOVA), three factorial ANOVA, and post hoc Bonferroni tests were used as statistical analysis (α = 0.05).

RESULTS

CM groups showed higher volumetric space measurements between the base and master model than 3D groups regardless of measurement region and cleft type, which refers to misfit (p ˂ 0.05). Cleft type differed in the adaptation of 3D groups yet not in CM groups (p ˂ 0.05). The volumetric space evaluation for the right measurement region resulted in higher values regardless of manufacturing method and cleft type (p ˂ 0.05).

CONCLUSION

Considering that 3D-printed feeding plates showed better adaptation compared to conventionally manufactured plates for all cleft types, 3D printing can be suggested as the manufacturing method of choice for feeding plates.

The Use of Ultrasound-Guided 3D-Constructed Obturator Device in the Management of Cleft Lip and Palate: A Case Series

Oral clefts represent a significant craniofacial anomaly in neonates, presenting multifaceted challenges such as feeding difficulties, recurrent ear infections, speech impediments, poor growth, hearing impairments, and dental misalignments. These anomalies not only affect physical health but also have profound psychosocial implications for affected individuals and their families. Current management strategies aim to address these challenges comprehensively, and recent advancements in technology have offered innovative solutions. Among these, the integration of ultrasound-guided (USG) three-dimensional (3D)-constructed obturator devices has emerged as a promising approach to enhancing patient outcomes, particularly in achieving facial symmetry and facilitating early nutritional rehabilitation. This study presents a detailed case series of three term infants born to non-consanguineous parents with appropriate birth weights for their gestational age, each diagnosed with a unilateral cleft lip and palate (UCLP). The first infant also presented with left-hand polydactyly and a preauricular sinus, while the second was diagnosed with multicystic kidney disease based on kidney, ureter, and bladder (KUB) scan findings. Collaborating with the Smile Train organization and the maxillofacial surgery team, a comprehensive management plan was devised. In the initial phase, intraoral scanning (Medit Intraoral Scanner™, Seoul, South Korea; done at Saveetha Medical College and Hospitals, Chennai) and digital printing of the obturator plate were performed to capture precise anatomical details. Subsequently, 3D printing technology (Ender 3D Printer™, Creality, Shenzhen, China; done at Saveetha Medical College and Hospitals, Chennai) was employed to fabricate a customized obturator plate equipped with a nasal stent. This ultrasound (US)-guided 3D-constructed obturator device was designed to fit each infant's unique oral anatomy, providing optimal support and alignment. The implementation of this device within a week post birth played a pivotal role in expediting the initiation of direct breastfeeding and nutritional rehabilitation. Furthermore, one of the infants underwent cleft lip surgical repair at four months of age, showcasing the device's compatibility with subsequent surgical interventions. The utilization of US-guided 3D-constructed obturator devices in the management of cleft lip and palate (CLP) has demonstrated significant clinical benefits. These devices contribute to reduced facial deformities, mitigate nasal cartilage sagging, and foster enhanced weight gain. Additionally, they facilitate successful breastfeeding, thereby promoting early nutritional recovery. Moreover, the improved facial symmetry and cheek fullness resulting from this approach contribute to accelerated rehabilitation, thereby reducing the societal stigma often associated with craniofacial anomalies.

Single-visit Feeding Obturator Fabrication in Infants with Cleft Lip and Palate: A Case Series and Narrative Review of Literature

Cleft lip and palate (CLP) is one of the most common craniofacial anomaly affecting newborns. In the early years of life to survive baby requires nutrition from the mother. Lip seal of infant is affected because of cleft palate and thereby feeding is greatly compromised. As there is communication between nasal cavity and oral cavity there are more chances of aspiration of milk into the lungs. The main role of pedodontist is to fabricate a palatal obturator which facilitates feeding. In this article we have discussed fabrication of feeding obturator in single visit in infants with cleft palate.