Effectiveness of the palatal orthopedic appliance in treatment of the unilateral cleft lip and palate patient

Abstract

Obturator therapy has been proposed for many years as an aid in maxillary orthopedics for the complete unilateral cleft lip and palate infant. The obturator appliance had the added benefit of providing a false palate against which the infant can suckle. This has aided in the feeding of these infants to assure adequate nutrition with the least effort for parent and child. The current study assessed three aspects of obturator therapy at James Whitcomb Riley Hospital for Children, Indianapolis, Indiana. Parental evaluations of the obturator proved to be very positive. Almost all parents (96%) rated it as beneficial and would recommend its use to other parents with cleft lip and palate infants. Weight gain analysis over the first nine months of life demonstrated that these infants were only slightly below the average for birth weight. At three and nine months of age, a number (69% and 56% respectively) had maintained their original weight percentile rankings or had just dropped into the next lower category. Thus, many of the infants were able to achieve adequate nutrition, a problem noted by many authors when obturator therapy was not used. It should be emphasized that each infant underwent either one or two major surgical procedures during this time period. Arch symmetry assessments at one, four and ten months showed a gradual reduction in lateral posterior crossbite, canine crossbite, and anterior crossbite tendency. Although the arches still showed some collapse at the end of ten months of age, the pattern was much better than at initial presentation with values much closer to normal. Improvements in arch symmetry was expected as the maxilla grew. From the results of this study, obturator therapy appears to be beneficial in maxillary orthopedics by helping to maintain adequate weight gain and gain parental acceptance.