American Journal of Advances in Medical Science www.arnaca.com eissn: 2347-2766 Case Report Prosthetic rehabilitation of the cleft palate patient with feeding plate: A Case report Sanajay Kumar 1*, Nirmal Rajm AP 1, Nivedita Pachore 1, Sudheer A 1, Lalitha Srivalli 2 1 Department of Prosthodontics, College of Dental sciences and Hospital, Amargadh-364 210, Gujarat, India 2 Dept of Oral Medicine and Radiology, College of Dental sciences & Hospital,Amargadh-364 210, Gujarat, India Abstract Cleft lip and palate is a most commonly observed congenital defect affecting orofacial region. One of the most common problems with such patients is interference in feeding. The treatment of the cleft palate patient is aimed to restore aesthetics, phonetics and functions, which can be achieved with the help of, fixed, removable or implant prostheses. This article describes a case report of prosthetic rehabilitation with feeding plate in 10 year old cleft palate patient. The patient was having cleft in the anterior maxillary palatal region, for which the step-wise impression procedures was followed to prepare the feeding plate. After follow-up, the patient showed significant improvement in the feeding problems, decreased the nasal regurgitation and improvement in speech was also noted. Results from the present case report states that we can reduce feeding problems, difficulties in speech and help in the development of the maxillofacial region of the patient. This not only decreases the physical and mental trauma in future of patient and also improves the quality of life. Keywords: Cleft palate, Feeding plate, Prosthetic rehabilitation Cite this article as: Sanajay Kumar, Nirmal Rajm AP, Nivedita Pachore, Sudheer A, Lalitha Srivalli. Prosthetic rehabilitation of the cleft palate patient with feeding plate: A Case report. American Journal of Advances in Medical Science. 2014; 2(4): 48-52. Source of Support: Nil, Conflict of Interest: None declared. 48
Introduction Clefts involving lips and palate are the most commonly seen congenital anomalies involving the maxillofacial region [1]. The etiology for clefts are multifactorial involving genetic as well as environmental factors. Any disturbances in the fusion of the separate areas of the face can result in formation of the cleft [2]. The patient of such defect have major problems with difficulties in feeding, because they cannot produce negative pressure in the oral cavity and thus will not able to move bolus of food backward to the pharynx, also these patients have nasal regurgitation, difficulties in speech, aesthetic problems and may also affect physical and mental growth of the patient [1,3,4]. To overcome such problems, feeding plates are advised to such patients, which obturates the cleft portion and helps to restore the separation between nasal and oral cavities [1,2]. The present article presents a case report of prosthetic rehabilitation of the 10 year old cleft palate patient with feeding plate. Figure-3: Intraoral picture of the patient showing presence of the cleft platate Figure-4: Preparation of temporary cast Figure-5: Fabricated custom tray prepared for mouth extensions Case report A 10 year old male patient was referred to the department with presence of cleft palate in the anterior maxillary region. Figure-1: Extraoral view of the patient (Front view) Figure-6: Fabricated custom tray prepared for mouth extensions Figure-2: Extraoral view of the patient (Lateral view) There is only one tooth was present in the maxillary arch, at the time of presentation, patient was having difficulty in feeding, nasal regurgitation and speech difficulties. There was also presence of underdeveloped maxilla (Figure-1,2 and 3). First, preliminary impression was taken and cast was 49
prepared, on which marking were drawn to make custom made tray, which was made from the self cure acrylic (Figure-4 and 5). Figure-7: Impression of the defect made with green stick moldable material (Figure-7 and 8). After this, temporary impression was made (Figure-9) and cast was poured (Figure-10). This cast was observed carefully for the presence of any undercuts. Figure-11 and 12: Final impressions Figure- 8: Impression of the defect Figure-12: Final impressions Figure-9: Temporary impression Then final impression was made (Figure-11 and 12) and the final impression cast was prepared (Figure-13). After this, the feeding plate was fabricated with the help of acrylic resin (Figure-14 and 15) and finally the proper fitting of the feeding plate was checked in the oral cavity (Figure-16). Figure-13: Final impression cast. Figure-10: Poured cast The tray was checked for extensions by placing intraorally (Figure-6). Then impression of the defect of the palate was Post-operatively patient had reduced the feeding difficulties and nasal regurgitation and a thorough follow up of the patient, revealed improvement of speech, 50
improvement in speech, and the patient felt confident due to improvement in aesthetics. Figure-14: Impression of feeding plate Figure 15: Impression of feeding plate Figure-16: Post-operative intraoral picture showing feeding plate at its place Discussion The main purpose of the feeding plates is to facilitate the function of the feeding by achieving the separation between oral and nasal cavities as tt produces a firm platform helping to produce the suckling reflex and give nutrition to the patient [5, 6]. Feeding plates also reduces the nasal regurgitation, reduces the length of time required for feeding, decreases the incidence of choking, helps to correct speech problems, assist in proper suckling reflex minimizes the oral stimulation and facilitates the development of oral motor system. The feeding plate places the tongue in correct position and prevents it from entering the defect; and thus prevents the tongue from interfering with the spontaneous growth of palatal shelves in the direction of midline. Ultimately the feeding plates decreases the severity of the skeletal and dental deviations and thus provides a positive impact on the patient as well as on their parents, as it decreases the parents frustration due to the feeding problems [7]. In the present case, the patient was having cleft in the anterior maxillary palatal region, for which the step-wise impression procedures was followed to prepare the feeding plate. After follow-up, the patient showed significant improvement in the feeding problems, decreased the nasal regurgitation and improvement in speech was also noted. Conclusion Adequate knowledge of the appliances and impression procedures is necessary for the management of patients with clefts involving lips and palate. It is demonstrated in the present case report that with the help of feeding plates we can reduce feeding problems, difficulties in speech and help in the development of the maxillofacial region of the patient. This decreases the physical and mental trauma in future of patient and ultimately improves the quality of life. References 1. Malik P, Agarwal A, Ahuja R. Feeding appliance for an infant with cleft lip and palate. Pak Oral Dent J. 2012;32(2):264-6. 2. Katge F, Dalvi S, Shetty A, Shetty S. Feeding Intervention in Cleft Lip and Palate Patients: A Review. Int J Dent Med Res. 2014;1(4):143-147. 3. Rizwaan AS, Sujoy B, Rajlakshmi B, Atif K. Prosthetic rehabilitation of cleft compromised newborns: A Review. J Clin Diag Res. 2010;4: 3632-8. 51
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