The Pin-Retained Prothesis in Cleft Palate Orthopedics

Abstract

Treatment of the infant with cleft lip and cleft palate has been associated with many marked advances in recent years. These can and should be incorporated into the treatment of these patients if we are to obtain the best possible results. The basic contribution to modern care was made by an orthodontist, McNeil of Glasgow, who first demonstrated that the maxillary segments could be moved into more normal relationships with the mandibular arch through the use of acrylic bite plates (4). For over one hundred years, orthodontists have appreciated the effects of abnormal or unbalanced lip and cheek musculature in producing serious alterations in the facial skeleton and significant disturbances of the dental occlusal relationships. Davis (2) was one of the pioneers to point out the significance of these relationships to the cleft lip and cleft palate problem specifically, and over thirty years ago made an appeal for closer cooperation between plastic surgeons and orthodontists in these cases. The purpose of our therapy of cleft palate patients is the early and continued separation of the oral and nasal cavities by a prosthesis in order to restore normal anatomy and function. As a result of this approach , more normal patterns of feeding, speech, dentition, hearing, and facial growth appear to be developed. In our opinion, this early mechanical restoration of the palate, simulating normal anatomy and assisting normal function, will greatly reduce, or perhaps eliminate, the need for treating the secondary problems. For example, the need for certain aspects of speech therapy will be reduced or eliminated through the transference from glottal stops to tongue-tip activity. The need for orthodontic treatment may be reduced by bringing the maxillary segments into proper relationship with the mandible and facial growth directed similarly toward the norm. Mechanical restoration of the palate permits normal use of the nipple for feeding and prevents, in large meas— ure, regurgitation of food into the nasopharynx, with its attendant middle-ear problems. Finally, it is our feeling that the permanent in—