This one is about: The Role of Obturators in Cleft Care
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THE ROLE OF OBTURATORS IN CLEFT CARE
There are two main roles for prosthetic appliances (obturators, or devices designed to cover the palate) in cleft lip/palate care. Those are the closure of a fistula (abnormal opening) and/or management of velopharyngeal insufficiency (inadequate throat muscles). We have also seen recent advances in palatalmaxillary appliances (devices that fit against the roof of the mouth) which realign the palatial bony segments in the early weeks after birth.
When a child is born with a cleft of the palate there is an opening between the nose and mouth. Immediate concerns center around feeding issues because the child will most likely have difficulty creating suction for a good swallow. Several feeding appliances were introduced to help "bridge" the gap. They include nipples with plates attached and acting as a substitute palate. Although these were useful in some cases, education about proper feeding techniques and nipple selection has proven to be more instrumental in successful breast and bottle feeding.
Obturators are a dental prosthesis designed to assist in the same way as the hard palate does: as a division between the nasal and oral cavities during speech. It is usually made of an acrylic material that is fastened to the teeth by dental clasps and can be either removable or fixed (cemented in place). It can be used as a primary management procedure for children with other health problems for whom surgery requiring general anesthesia should be avoided, for children who have very wide clefts and little tissue, or for parents who wish to avoid cleft surgery for other reasons. It can also be used as a secondary management procedure for children who develop fistulas in the palate following palatial surgery. In this way, a separation is created between the nose and mouth which may decrease nasality and help keep food or liquids out of the nose.
When treating velopharyngeal insufficiency, an obturator can be fitted with a speech bulb that acts as a palatial lift. This process is usually considered temporary unless there are no surgical options. A more recent use of speech bulb appliances has been in "bulb reduction" programs. The main goal of these programs is to stimulate the lateral pharyngeal wall (side walls of the throat) movement. A child is initially fitted with a speech bulb that enables complete velopharyngeal closure, then the bulb is gradually reduced in size until it is eliminated. It is felt that this technique can help produce velopharyngeal closure (an ability to close the space between the soft palate and the back of the throat).
When considering your options for cleft management, talk to the Speech/Language Pathologist on your team. They will be able to help you make decisions based on your child's individual needs. Obturators can be a valuable tool in decreasing nasality, which in turn will help with proper articulation.
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