Prosthetic Management of Cleft Lip and Palate

This article on provides an overview about the when, why, and how the prosthetic management helps the clients with cleft lip and palate.

Prosthetic Management in cleft lip and palate

A cleft lip and palate is a birth defect that occurs when the tissues of the lip and/or palate of the fetus do not fuse very early in pregnancy.

Most of the cleft lip and palate population exhibits these problems:

     – Feeding difficulties

     -Speech disturbances

     -Ear Infections

     -Dental problems

     -Psychosocial  disturbances    

The management of clients with cleft lip and palate is broadly in terms of surgical intervention, prosthetic rehabilitation and behavioural management.

Prosthesis is an artificial device that replaces a missing body part .Prosthesis in cleft palate  is to restore and correct congenital or acquired defects in the palate and related structures if they are involved.

Why do we need Prosthesis?

To  restore various functions:

Ø  breathing,

Ø  mastication,

Ø  Restore the dental arch,

Ø   Allow the normal swallowing/deglutition,

Ø  Regulate the air column in the oral cavity to build pressure,

Ø  Restore the missing soft palate,

Ø  psychological well-being of the patient.

With respect to speech pathologist main goal of the prosthesis is to restore the socially acceptable speech.

—  Candidates can be selected based on various aspects:

-          Surgery to the cleft palate

         – Unoperated  palate

         – Operated palate

-           General health of the patient.

-           Psychological status includes motivation of the client.

Un-operated palates:

  1. A wide cleft with insufficient local tissue available to accomplish a functional repair.
  2. A wide cleft of the hard palate which cannot be closed by a vomer flap or other local tissue.
  1. Neuromuscular deficit of the soft palate and pharynx.

4.       Cases with a justified medical contra-indication to surgery) or when a surgery is delayed.

5.       Expansion prosthesis for improvement of spatial relationships.

6.       combined prosthesis and orthodontic appliance.

—  Overall Criteria For Selection Of Patients For Prosthodontic management…

—  Good oral hygiene

—  Acceptable occlusion

—  Adequate retention available

—  Positive assessment indications

—  Commitment to complete treatment

—  Regular speech therapy available

—  Age appropriate cooperation

Contraindications for selecting candidate for prosthetic management

—  Poor dentition

—  Poor oral hygiene

—  Advanced perioral dental disease

—  High carries rate

—  Strong gag reflex

—  Lack of a trained prosthodontist.

Advantages of using a prosthesis:

Ø  Can be used instead of surgery

Ø  Not a permanent correction- can be altered depending on the needs

Ø  Not expensive

Ø  Simple device

Ø  Versatility – can be designed to accommodate the other types also

Ø  Improves speech intelligibility

Disadvantages of using a prosthesis

Ø  Unlike surgery- do not result in permanent correction

Ø  Uncomfortable to wear – cause ulceration of surrounding mucosa

Ø  Remove in the night- might be lost

Ø  Manual dexterity – not possible in MR and other cases

Ø  Require frequent adjustment as the child grows

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