A Preoperative Appliance for a Newborn with Cleft Palate

In this article, Karayazgan, Gunay, Gurbuzer, & Erkan, (2008) introduce the use of a familiar treatment method for infants with cleft palate: the use of a nasopharyngeal obturator. However, the obturator that is being presented in this article is different from the conventional appliance. This obturator uses tulle: a soft, durable fabric, in place of the traditional rigid material that is most often used.

Studies have shown that the earlier a nasopharyngeal obturator is inserted into the mouth of a child with cleft palate, the more beneficial it will be. Children with cleft palate have great difficulty obtaining adequate nutrition due to the fact that they cannot maintain enough pressure to suck. Inserting an obturator before surgical procedures to repair the cleft allows for greater maxillary growth, reduces feeding time, helps to prevent choking, nasal regurgitation, and excessive intake of air. The nasopharyngeal obturator provides a covering for the cleft by covering the hard palate and extending posteriorly to elevate the soft palate. This helps the child’s speech to develop more clearly, and allows the tongue to be positioned correctly. Karayazgan et al. (2008) state that the use of tulle to connect the bulb and plate of the obturator is cost efficient and will most likely not cause as much, if any, irritation or damage to the soft tissue in the mouth.

In this article, a study of a three day old baby with a cleft palate was discussed. Karayazgan et al. (2008) reported that a soft palate obturator was requested for this baby so that he could feed effectively until a surgical option was available. Impressions were taken and an obturator was made, using tulle as a connecting middle fabric between the two pieces. The obturator was inserted, and the infant was observed for a few hours before being sent home. After a few initial nausea and gagging reflexes, the infant adapted well to the new device. The baby was able to feed, and gained weight at a normal rate.

Karayazgan et al. (2008) claim that the use of tulle in a nasopharyngeal obturator is a cost efficient and viable option for infants with cleft palate defects. Tulle is durable, flexible and helps an infant to feed more efficiently by imitating the function of the velum. Using this material is a valuable resource for aiding children with cleft palate by giving them a better quality of life.

References 

Karayazgan, B., Gunay, T. Gurbuzer, B., Erkan, M., & Atay, A. (2009). A preoperative appliance for 

     a newborn with cleft palate. The Cleft Palate-Craniofacial Journal: Official Publication of 

     the American Cleft Palate-Craniofacial Association, 46(1), 53-57. doi: 10.1597/07-093.1.