Rahul L et al.
: Feeding Appliance for a 2 day old Neonate with Cleft Lip and Palate CASE REPORT
A Feeding Appliance for a 2 day old Neonate
with Cleft Lip and Palate: A Case Report
Lodaya Rahul1, Dave Ankita2, Kunte Sanket3, Shah Rohan4
Correspondence to:
1,3-Associate Professor, Department of Pedodontics and Preventive Dentistry, Bharati Dr. Dave Ankita, Postgraduate Student,
Vidyapeeth Deemed University Dental College and Hospital, Pune. 2-Postgraduate Student, Department of Pedodontics and Preventive
Department of Pedodontics and Preventive Dentistry, Bharati Vidyapeeth Deemed University Dentistry, Bharati Vidyapeeth Deemed
Dental College and Hospital, Pune. 4-Assisstant Professor, Department of Pedodontics and University Dental College and Hospital, Pune.
Preventive Dentistry, Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune. Contact Us: www.ijohmr.com
ABSTRACT
Congenital cleft lip and palate is the most commonly found craniofacial defect. The most common problem in an infant
with cleft lip and palate, is the difficulty in feeding due to communication between oral and nasal cavity. Feeding
obturator restores this gap and assists in feeding as well as helps in reduction of airway problems, regurgitations, and
frequent infections. This clinical report describes a technique for fabricating feeding plate in a 2-day old neonate with a
cleft lip and palate.
KEYWORDS: Cleft lip, Cleft Palate, Obturator
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INTRODUCTION
nasal regurgitation, and choking. A feeding appliance is a
Learning to live with a change in one’s appearance as a
favorable option in such cases as it obturates the cleft
result of injury or disease is difficult. It is all the more
area and creates a stable platform toward which the baby
difficult for children born with developmental defects and
can press the nipple and extract milk. 5
their parents to adjust. The treatment of orofacial clefts
requires an exhaustive treatment schedule which puts Various types of feeding plate like passive plates,
enormous mental, physical, and financial stresses not molding plates, and lathams obturator are available to
only for the parents but for the entire family. assist in feeding. 6
Clefts of the lip and palate are the most common In the fabrication of feeding plate, impression taking is
congenital deformities with an overall incidence of 1:700 one of the most crucial steps. Patient positioning should
in live human births. 1 Among unilateral clefts, clefts of be carefully done and if possible vitals should be
left side are more common (70% of cases). 2 monitored in neonates. Different methods like use of ice
cream stick, spoon, and customized trays can be used for
Clefts have a complex etiology where both genetics and
taking impressions. Materials with limited flowability
environment play a major role. Risk factors such as folic
like elastomeric impression materials should be used to
acid deficiency, maternal age, and maternal smoking have
avoid airway obstruction. A high volume suction should
been associated with it. Various genes – namely the T-
be used in case of regurgitation of stomach contents. 6
box transcription factor-22 (TBX22) gene, poliovirus
receptor like-1 (PVRL1) gene, and interferon regulatory In the present case report, a feeding obturator was given
factor-6 (IRF6) gene are associated with X-linked cleft to a 2-day old neonate with cleft lip and palate.
palate (Syndromic Cleft), cleft lip/palate-ectodermal
dysplasia syndrome, and Van der Woude’s (VWS) and CASE REPORT
popliteal pterygium syndromes, respectively. These are
also found to be associated with nonsyndromic cleft lip A 2 days old healthy male neonate reported to our
and palate. 3 department with a cleft lip and palate with feeding
difficulty. The patient had a patent gastric tube for
These affect several systems that include feeding, facial feeding. [Figure 1] Medical history of the child and
growth, dentition, mastication, deglutition, speech as well parents was non-contributory. Pregnancy and delivery
as social and psychological problems. 4 were uneventful with no relevant maternal medical or
Feeding in an infant with cleft lip and palate infant is a dental history.
major challenge due to an abnormal oronasal Intraoral examination of the child revealed a unilateral
communication in these patients. These infants have cleft lip and palate (Veau Class III). [Figure 2] A
difficulty in making a seal around the nipple of the preliminary impression was made in a NICU setup.
mother or the bottle.
The infant was placed in a supine position and vitals were
In addition, these infants have an excessive air intake, monitored. Polyvinyl siloxane putty material was used for
How to cite this article:
Lodaya R, Dave A, Kunte S, Shah R. A Feeding Appliance for a 2 day old Neonate with Cleft Lip and Palate: A Case Report. Int J Oral Health Med Res
2017;3(6):86-89.
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MARCH-APRIL 2017 | VOL 3 | ISSUE 6 86
Rahul L et al.: Feeding Appliance for a 2 day old Neonate with Cleft Lip and Palate CASE REPORT
Figure 4: Primary Cast With Spacer
In the next appointment, final impressions were taken
using elastomeric putty material and the final casts were
poured in dental stone. [Figure 5] 19 gauge wire was then
bent into an omega shape and was embedded in the
acrylic plate. The tray was smoothened and polished to
avoid any irritation to tissues during impression. [Figure
6].
Figure 1: Patient With Patent Gastric Tube
A Figure 5: Custom Impression Tray
Figure 2: Cleft Lip And Palate
the preliminary impression. The sectional impression was
taken using fingers and was later joined. [Figure 3] A
primary cast was poured in dental stone. A spacer was
then adapted on the cast, and a custom tray was then
prepared using self-cure acrylic. [Figure 4]
Figure 3: Primary Impression Figure 6: Feeding Plate
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MARCH-APRIL 2017 | VOL 3 | ISSUE 6 87
Rahul L et al.: Feeding Appliance for a 2 day old Neonate with Cleft Lip and Palate CASE REPORT
At the delivery appointment, the oral plate was carefully The use of feeding tube which is started early can cause
fitted in the infant’s oral cavity. Initial attention was soft tissue perforation due to hardening of the tube. It also
given to the retention of the obturator. Care was also produces rare complications such as urinary bladder
taken to prevent the obturator extensions from impinging perforation, pericardial sac perforation, and
on any muscle attachment or extending to the vestibular Enterobacteriaceae colonization.4
depth. [Figure 7]
An evaluation of the feeding practices showed
unsuccessful direct breast feeding and the use of acrylic
plate was considered helpful by a majority. Early
management is a necessity as nonsyndromic clefts do
affect the quality of life in school-age children that also
affects their social role. Thus an early intervention by
conservative means should be carried out to decrease
complications by increasing body weight and thereby
decreasing risk of complications during surgery.10
Neonatal feeding obturator appliance is traditionally
fabricated of acrylic resin that serves the following
purposes:
Creates a rigid and stable platform for feeding
Reduces nasal regurge
Reduces the time required for feeding and increases
the amount of feed intake per feed
Figure 7: Feeding Plate in Place
Helps position the tongue away from the cleft area to
Parents were instructed on placement and removal of the allow spontaneous growth of palatal shelves.
appliance and its regular maintenance. Parents were also Reduces parents’ frustration as a result of feeding
instructed to use the plate as much as possible. problems. 10
The infant was recalled for any adjustments a week after
initial delivery of the appliance. Mother was enquired CONCLUSION
regarding the use of feeding plate. A steady weight gain Early non-surgical intervention is of prime importance in
was also seen. The oral cavity was examined for any a cleft lip and palate infant. It not only helps in feeding
possible soreness or ulcerations. Oral hygiene and the infant but also modifies the growth and prevents
feeding instructions were reinforced. future complications. It prepares the baby for an early
surgical intervention by facilitating the growth of the
DISCUSSION infant.
Most parents are traumatized when a child is born with an Ideally, if clefts are diagnosed antenatally, parents should
orofacial cleft as there is an increased financial, social, be guided and educated about the need and use of
and personal impact prior to primary treatment obturators even before the baby is born. Inadequate
completion. The problems in coping are more in families nourishment due to difficulty in feeding in such cases
with children having cleft lip and palate when compared lead to a lag in growth and act as a stumbling block in
to families with isolated cleft palate.7 achieving developmental milestones. An obturator
bridges the gap between a healthy and a weak cleft lip
The present line of management involves a reparative and palate patient.
surgery within the first 12 months of life. At this point of
time the body weight varies between 5 and 10 kg and the REFERENCES
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