This one is about: Use of the Latham Pin Device in Early Alveolar Alignment
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USE OF THE LATHAM PIN DEVICE IN EARLY ALVEOLAR ALIGNMENT
by Dr. Frederick Lukash
Clefting deformities present physical and psychological challenges for the families for the affected child and the physicians who treat them. Short of rewriting reality, there is nothing which can soften the blow or adequately compensate for the traumatic experience. It is natural for parents to go through stages of fear, anxiety and guilt.
The role of the plastic surgeon is a crucial one. This is the key player on the team who must provide the most natural appearing and functional facial restoration possible.
Past approaches to cleft lip and palate deformities have focused simply on early closure of the lip with little attention paid to the underlying bone and dental arches. Bypassing correction of these crucial structures has resulted in alveolar collapse, oral-nasal fistulas and nasal deformities. Late correction of these problems requires multiple and complex surgical and dental operations extending into adolescence.
A more progressive approach is to insert a dynamic palatial maxillary appliance in the early weeks after birth to painlessly realign the clefted bony segments into normal position. Then in one surgical procedure the dental arch is fused, the oral-nasal fistula closed, the nose realigned and the lip repaired in a tension-free fashion. When the hard and soft palate are closed at one year, the major structural, aesthetic and functional burdens have been lifted.
To create these dramatic advances, a closely coordinated relationship between the plastic surgeon and the prosthodontist is necessary. Within the first week of life the prosthodontist fabricated a static (non-mobile) splint to prevent the clefted segments from further motions. This "denture" also helps in feeding by creating a "palate" to suck up against. At age 6 weeks the static splint is exchanged for a "dynamic splint". This has been carefully and scientifically designed to move the cleft segments into a normal dental arch. This appliance is held into place with small pins. These are inserted in the operating room while the child is asleep. The procedure lasts about 15 minutes and the baby goes home that day. By 3 months the arches are aligned and the child is ready for definite closure of the lip, alveolus and nose complex. The hard and soft palate is closed as a unit at one year. From this point on additional procedures are performed only if there are specific isolated speech or growth and development corrective problems. All the children are frequently reevaluated so they can be the best possible. Because the care of these children is complex, it is important that the pediatrician or obstetrician be educated so as to refer the child to a plastic surgeon skilled in cleft care. He in turn will enroll the child in a regional cleft lip and palate center to further coordinate the additional care needed (social services, psychologists, genetic counseling, hearing and speech, dental care, and parent support groups).
An important final thought - the birth of a child with a clefting problem will herald trying times. However, they are rarely affected with other illness or deformity. It is important for families to associate themselves with surgeons with compassion as well as skill who are devoted to the healthy growth and development of these children.
----------------Dr. Frederick Lukash is a member of the Cleft Lip and Palate teams of North Shore University Hospital and Schneider Children's Hospital at Long Island Jewish Medical Center. He has offices in Long Island and in Manhattan.
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