Prosthetic management of an adult cleft patient with velopharyngeal appliance and airway evaluation by acoustic pharyngometry

Cleft lip and palate is the most common congenital malformation in oro-facial region. In adult cases where defect is large and paucity of tissue is there, prosthetic management of the defect with palatal obutrator and velopharyngeal appliance is the treatment of choice. It requires scrupulous clinical skills and detailed knowledge of anatomy to prevent airway obstruction and discomfort during function. Acoustic pharyngometry (AP) is an advanced tool to evaluate the airway in 3D during function without radiation exposure. In this case report palatal obturator with speech aid prosthesis was fabricated to rehabilitate an adult cleft palate patient. AP test was done to ensure adequate airway space with prosthesis.

Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation

Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.

Evaluation of the Differences Between Conventional and Digitally Developed Models Used for Prosthetic Rehabilitation in a Case of Untreated Palatal Cleft

Objective: The virtual cone beam computed tomography–derived 3-dimensional model was compared with the scanned conventional model used in the fabrication of a palatal obturator for a patient with a large palatal defect. Design: A digitally derived 3-dimensional maxillary model incorporating the palatal defect was generated from the patient’s existing cone beam computerized tomography data and compared with the scanned cast from the conventional impression for linear dimensions, area, and volume. The digitally derived cast was 3-dimensionally printed and the obturator fabricated using traditional techniques. Similarly, an obturator was fabricated from the conventional cast and the fit of both final obturator bulbs were compared in vivo. Results: The digitally derived model produced more accurate volumes and surface areas within the defect. The defect margins and peripheries were overestimated which was reflected clinically. Conclusion: The digitally derived model provided advantages in the fabrication of the palatal obturator; however, further clinical research is required to refine consistency.

A Palatal Speech Bulb—A Case Study

Palatal defects of the oral cavity can be either congenital or acquired following trauma or surgical excision of malignant disease. Palatal defects can greatly affect function and subsequent quality of life. Rehabilitation using a removable obturator can be a preferable treatment option as it allows regular review post-surgery. This case study reports on the design and construction of a removable “speech bulb” obturator. A 50-year-old female patient presented complaining of nasal regurgitation and looseness of her current palatal obturator. She had previously undergone wide surgical excision of her soft palate under general anaesthesia due to adenoid cystic carcinoma. Treatment consisted of the provision of a new removable obturator, paying careful attention to the design of the “speech bulb” itself. The design of the “speech bulb” is crucial to optimise function, and the method of prosthesis fabrication is fully described. This case highlights the impact of obturator fit on a patient’s quality of life and will be of benefit to clinicians from many disciplines including dentists, oral and maxillofacial surgeons, Ear, Nose & Throat (ENT) surgeons and speech and language therapists.

A Feeding Appliance for an Infant with Cleft Palate

Cleft palate and cleft lip are the most common congenital deformities involving the orofacial region. One of the most important problems with this deformation is difficulties with feeding due to lack of sufficient negative intraoral pressure which prevents regurgitation of food into the nasal cavity. Cleft lip and cleft palate can be surgically treated but repair of the palate is usually delayed until 6 months to 2 years of age. Early repair of the palate may have a negative effect on the growth and development of maxilla due to the resulting scar tissue. This article presents the Prosthodontic management of an infant with a cleft palate through fabricating a feeding plate (palatal obturator). Keywords: Cleft palate, Feeding plate, Palatal obturator