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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 64-67

A single-visit feeding plate for a 14-day-old neonate with cleft palate


1 Department of Prosthodontics, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
2 Department of Prosthodontics, Rajah Muthiah Dental College and Hospital, Annamalai Nagar, Tamil Nadu, India

Date of Web Publication11-Oct-2019

Correspondence Address:
Dr. S Mohammed Imthiyas
Plot No 38, Sardar Patel 1st Street, ECR Road, Kanathur, Kancheepuram - 603 112, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_41_18

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  Abstract 


Cleft palate is the most common congenital maxillofacial defect, compared to clefts of other facial structures. A feeding plate is a prosthetic aid designed to obturate the cleft so that the infant can generate negative pressure within the oral cavity, which is necessary for sucking. A 14-day-old infant, with no contributory medical and family history, was referred to the department of prosthodontics. The mother reported that the infant was not able to suckle milk properly even with the use of typical cleft nipples or squeezable bottles. The final impression was made with very high-viscosity condensation silicone rubber base impression material. The secondary impression was poured with dental stone to obtain a master cast, blocking out the undercuts with pink wax, and then, the plate was fabricated using self-cured acrylic resin. The feeding plate was checked in the dental clinic, and the patient's mother was asked to feed the baby. Instructions were provided on how to use, clean, function, and maintain the feeding appliance. The feeding plate was delivered on the same day considering high anxiety of the mother regarding the diminished weight of her infant relative to his age.

Keywords: Cleft palate; feeding plate; heat cure acrylic; neonate


How to cite this article:
Imthiyas S M, Subramanian B, Karupiah P, Urjan K, Karthik V C, Karthik R. A single-visit feeding plate for a 14-day-old neonate with cleft palate. Indian J Multidiscip Dent 2019;9:64-7

How to cite this URL:
Imthiyas S M, Subramanian B, Karupiah P, Urjan K, Karthik V C, Karthik R. A single-visit feeding plate for a 14-day-old neonate with cleft palate. Indian J Multidiscip Dent [serial online] 2019 [cited 2019 Dec 10];9:64-7. Available from: http://www.ijmdent.com/text.asp?2019/9/1/64/268993




  Introduction Top


Cleft palate is the most common congenital maxillofacial defect and occasionally cleft of other facial structures. Cleft pathogenesis[1] occurs early during embryonic development and results from the failure of fusion of various facial processes. Hence, a multidisciplinary approach is needed in the treatment of infants with the cleft. Repair of the cleft palate is delayed until 12 months to 2 years of age.[2],[3] During this period, maintenance of adequate nutrition is essential to allow the proper growth of the newborn. Feeding process in a cleft lip and palate child is usually difficult and feeding time is very long. Nasal regurgitation, frequent burping due to excessive air intake during deglutition, and choking are associated problems that make feeding complicated for both the cleft baby and the parent.

There are different approaches to feed babies with cleft palate. Orogastric and nasogastric tubes[4] are effective but only to the limited period. A feeding plate is a prosthetic aid designed to obturate the cleft so that the infant can generate negative pressure within the oral cavity,[5] which is necessary for sucking. It also corrects the tongue posture and stimulates the spontaneous growth of maxillary segments toward each other preventing the tongue from entering the defect.[6] Conventional feeding plates cover the hard palate and extend posteriorly to contact the soft palate.


  Case Report Top


A 14-day-old neonate [Figure 1], with no contributory medical and family history, was referred to the Department of Prosthodontics and Crown and Bridge, Rajah Muthiah Dental College, Annamalai University, Tamil Nadu. The mother reported that the infant was not able to suckle milk properly even with the use of typical cleft nipples or squeezable bottles. Intraoral examinations revealed a cleft in the uvula, soft palate, and secondary hard palate (Veau's Classification Type 2).
Figure 1: Preoperative

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Fabrication of the feeding plate

A primary impression was made using a low-fusing impression compound. First, the defect was filled with a piece of Vaseline gauze, and then, the green stick was softened in warm water and kneaded with caution to avoid thermal injury. A stainless steel spoon [Figure 2] was used to carry the impression material into the neonate's mouth, and the material was gently pressed against the hard palate and into the buccal and labial vestibules [Figure 3], while the baby was held in the prone position in the mother's lap. During this step, the infant was crying. The impression was inspected thoroughly [Figure 4]; it had satisfactorily covered all the supporting areas for the feeding plate. Then, a primary model was obtained using Type 2 dental stone [Figure 5]. The primary model was carefully inspected to finally determine the borders of the special tray. A 2-mm wax spacer was adapted to the primary model, and the special tray was constructed with the use of a self-curing fast-setting acrylic resin [Figure 6]. The final impression was made with very high-viscosity condensation silicone rubber base impression material [Figure 7]. The secondary impression was poured with dental stone to obtain a master cast, blocking out the undercuts with pink wax, and then, the plate was fabricated using self-cured acrylic resin. Finally, the edges of this plate were trimmed [Figure 8]. During the process, a hook was fabricated using 21-gauge wire for knotting. Approximately 3-inch cotton thread was passed through and tied to the eyelet (made by 21-gauge wire) of the feeding plate. The prosthesis was trimmed, finished, and polished. Then, it was examined in the patient's mouth; thereafter, minor adjustments and final polishing of the feeding plate were carried out.
Figure 2: Stainless steel spoon tray

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Figure 3: Primary impression by low-fusing compound

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Figure 4: Finished primary impression

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Figure 5: Primary model

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Figure 6: Special tray fabricated

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Figure 7: Secondary impression

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Figure 8: Fabricated feeding plate

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The feeding plate was checked in the dental clinic [Figure 9], and the patient's mother was asked to feed the baby [Figure 10]. Instructions were provided on how to use, clean, function, and maintain the feeding appliance. Monthly follow-ups were planned after 1st, 3rd, and 6th months respectively, and the mother was informed that the feeding plate could be replaced to accommodate the craniofacial growth before surgical intervention. The infant gained weight normally during the follow-up period. The previously described procedure was conducted on the same day the patient was admitted into the hospital.
Figure 9: Postoperative insertion

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Figure 10: Feeding plate hook tied with a knot

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  Discussion Top


The main objective during the first months of cleft palate infant's life is proper weight gain, which results from proper feeding, making the infant ready for the future surgical correction.[7] Construction of a feeding appliance not only fills the gap between the nasal and oral cavities but also achieves the maximum treatment benefits for such patients; at the same time, it increases awareness and enhances the skills of diagnosis and management aspects of all the specialists in the interdisciplinary team.

Making an impression is the first challenging clinical step in cleft palate (CP) infants due to a lack of cooperation on behalf of the patient. The oral cavity is too small to be adequate for commercially available impression trays, with a risk of impression material swallowing and aspiration[8] or even being lodged in the undercuts of the defect. Therefore, it is important to take care of infant positioning, the tray used, and the impression material to maintain airway patency during impression making.

Filling the defect with a piece of Vaseline gauze helped reduce to a minimum any possibilities of impression material lodgment within the defect. The impression compound was softened and placed on a stainless steel spoon to accommodate the small-sized oral cavity. Prone position was essential in keeping the tongue at forwarding position, avoiding posterior regurgitation of the impression material. Infant crying was satisfactory for ensuring airway patency and the elimination of any possibilities of impression material aspiration. The primary impression material was poured with dental stone due to its rapid setting and since the primary cast was only used for the construction of the special tray.

The special tray was made of self-curing acrylic resin to obtain enough rigidity to carry the secondary impression material. To obtain proper surface details, the second impression was taken with heavy putty type in the current case because of its high viscosity which reduces the aspiration risk. In addition, it reproduces all the areas of interest, while low-viscosity light body[9] was used for improving details of the areas away from the defect without tearing and/or being lodged in the defect. The final feeding plate was fabricated using fast-setting self-curing acrylic resin to construct a single-day feeding appliance to avoid multiple visits. The plate was tied with silk to facilitate easy insertion and removal of the prosthesis and to act as a safety measure to prevent swallowing of the appliance.[10] The feeding plate was delivered on the same day considering high anxiety of the mother regarding the diminished weight of her infant relative to his age. The normal weight gain of the infant indicated the proper function of the feeding plate.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Adam MR. Dean Dentistry for the Child and the Adolescent. 9th ed. St. Louis: Mosby; 2011. p. 614-37.  Back to cited text no. 1
    
2.
El-Alkamy A, Elsayed AF. Birth prevalence of cleft lip and/or palate in Alexandria. ED J 2015;61:5625.  Back to cited text no. 2
    
3.
Balkhair M, Abdul-Sayed SS, Fahim F. Birth incidence of cleft lip and/or palate in Dakahlia Benisuif a survey study. ED J 2016;62:2523.  Back to cited text no. 3
    
4.
Burg ML, Chai Y, Yao CA, Magee W 3rd, Figueiredo JC. Epidemiology, etiology, and treatment of isolated cleft palate. Front Physiol 2016;7:67.  Back to cited text no. 4
    
5.
American Academy on Pediatric Dentistry Clinical Affairs Committee, American Academy on Pediatric Dentistry Council on Clinical Affairs. Policy on management of patients cleft lip/palate and other craniofacial anomalies. Pediatr Dent 2008;30:238-9.  Back to cited text no. 5
    
6.
Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial anomalies. American Cleft Palate-Craniofacial Association. March, 1993. Cleft Palate Craniofac J 1993;30 Suppl 1:S1-16.  Back to cited text no. 6
    
7.
Ize-Iyamu IN, Saheeb BD. Feeding intervention in cleft lip and palate babies: A practical approach to feeding efficiency and weight gain. Int J Oral Maxillofac Surg 2011;40:916-9.  Back to cited text no. 7
    
8.
Reichert F, Amrhein P, Uhlemann F. Unnoticed aspiration of palate plate impression material in a neonate: Diagnosis, therapy, outcome. Pediatr Pulmonol 2017;52:E58-60.  Back to cited text no. 8
    
9.
Jones SD, Drake DJ. Case series of undetected intranasal impression material in patients with clefts. Br J Oral Maxillofac Surg 2013;51:e34-6.  Back to cited text no. 9
    
10.
Duarte GA, Ramos RB, Cardoso MC. Feeding methods for children with cleft lip and/or palate: A systematic review. Braz J Otorhinolaryngol 2016;82:602-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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