Friday, March 5, 2010
Our patient I will call 'M' has lived with the defect of unilateral cleft lip and palate since he was born 10 years ago. It is disfiguring, causes difficulty chewing, makes pronunciation of words nearly impossible, and forces M to live with a chronic sinusitis and runny nose as the nasal turbinates are directly exposed to the mouth. Despite this M is seen on the playground adjacent to the pediatric ward with a gigantic grin as he comes down the slide.
M was referred to dental after an unsuccessful surgical attempt was made to close the lip and palate (the wound dehisced and separated). A second surgical opinion thought the distance (probably 10-15 mm) was just to severe to achieve a successful union of the lips and covering of the palate.
Winnie taking an impression on M for a perhaps a newly invented appliance we are calling a rapid palatal condenser (RPC).
You may know about the traditional appliance the Rapid Palatal Expander (RPE) or better known as Hyrax if you had orthodontics as a child and suffered from a posterior cross bite. The RPE consists of a screw attached to the posterior teeth. The device is designed to break the palatal suture of the developing child in a short time period. With each twist of the screw over a two week period the device separates .25 mm and the teeth begin to move laterally into their correct position. Some feel the RPE is more of torture device because it causes pain (even a sound as the boney palatal midline suture breaks), headache, and gap in between the upper central incisors with each twist of the screw by their parents.
We reasoned that if you can use a RPE to expand the palate, why not use a RPC to bring a cleft palate and lip together.
You can see the appliance above cemented in place. We are giving it a few turns of the screw each day to see if we can achieve sufficient closure that M can go for surgical repair.