Management of Increased Nutritional Intake in Baby cleft lip and sky-

Sky with Obturator Feeding Plate

1 Elizabeth Mailoa, 2 Vinsensia Launardo, 3 Rifaat Nurrahma

1 Section Prosthodonsi FKG UNHAS
2 PPDGS Prosthodonsi FKG UNHAS
Faculty of Dentistry, Hasanuddin University
Makassar, Indonesia

ABSTRACT
Lip and palate cleft congenital is a complex malformation which involved facial soft and
hard tissue. Child born with Lip and palate cleft will face both functional and esthetical
challenges. Palate cleft will result in an inability to generate Sufficient oropharyngeal
negative pressure and tongue compression against the palate, causing milk to reflux into
the Nasal cavity and associate d problems such as respiratory difficulties and fatigue.
These feeding problems will affect Nutrition intake and baby's body weight which will
prevent the baby from undergoing reconstruction surgery on Appropriate time. Feeding
plate obturator comprising an acrylic palatal coverage improved sucking ability and
Manages the issue.
Keyword : lip cleft, palate cleft, obturator, feeding plate

ABSTRACT
Congenital cleft lip and palate are complex malformations involving hard and soft tissues
face. Babies born with cleft lip and palate will experience functional and aesthetic
challenges. Gap The ceiling will result in inability to produce sufficient oropharyngeal
negative pressure and tongue Unable to press the ceiling, so the milk will flow back to
the nasal cavity and cause problems Breathing. This will affect the intake of nutrients and
low weight, so the baby may be Unable to undergo surgical treatment of reconstruction
in time. Obtrurator feeding plate made of acrylic To close the ceiling increases the baby's
sucking ability and can solve this problem.
Keywords : cleft lip, cleft palate, obturator, feeding plate

PRELIMINARY
Cleft lip and congenital ceilings are complex malformations involving tissue Hard
and soft faces. Babies born with cleft lip and palate will experience challenges Functional
and aesthetic that require interdisciplinary treatment of various sciences to regain
Pronunciation, occlusion, facial appearance and confidence to the maximum
extent possible. 1 Babies with cleft lip usually have no problems with breastfeeding. But
the sky- The sky will result in inability to produce sufficient oropharynx negative
pressures and tongue Unable to press the ceiling, so the milk will flow back to the nasal
cavity and Causing respiratory problems. This causes baby difficulty to get nutritional
intake Which ultimately leads to low weight and growth problems. Weight Which is an
adequate requirement that a baby can undergo construction surgery at a time right.
Obtrurator feeding plate made of acrylic to cover the ceiling increase The ability to suck
baby so that it can help improve baby's health status. 1,2
CASE

Figure 1 Extra oral photos of patients

A 14-day-old baby A from M city was taken by his parents to RSGMP FKG
UNHAS Makassar With disability complaints making it difficult to breastfeed. Historical
examination during pregnancy, Mother of the baby Experiencing heavy cravings so that
the mother's diet consists mostly of instant food. From the examination Clinically it was
found that infants had unilateral complete sinistra labiognatopalatoschizis

GOVERNANCE
Printing is done using a baby print spoon. After the size of the print spoon
Accordingly selected, the patient is paired with oxygen cylinders to prevent anoxia.
Printing done with Using elastomeric printing materials. After printing the setting , the
print spoon is removed from the inside Mouth carefully (Fig 1). The printout is boxed and
casted using a dental plaster type II (Fig.2). After hardening, the defect and undercut
portions of the gypsum model (Figure 3) are identified and Closed by night. Obturator
feeding plate is made using acrylic (Figs 4, 5 and 6).
Fig 1 Printout by using printed material Elastomers

Fig 3 The printout is then boxed and casted

After the obturator feeding plate is completed, try in the patient (Fig 7). After the
obturator Can be installed properly, soft liner is applied by direct method (Fig 8 and 9).
Baby mother then Instructed to breastfeed her baby. The baby looks smoothly
breastfeeding and does not choke anymore. Parents The patient is then taught how to care
for and clean the obturator. The control is done on the 1st day,
3rd, and 7th day after insertion (Figure 10).
Fig 3 Work model Fig 4 Obturator feeding plate

Fig 5 Obturator feeding plate on the working model

Figure 6 An intaglio obturator feeding plate section before Application of soft liner
Fig 7 Try in obturator feeding plate in infants

Fig 8 Application of soft liner on feeding obturator Plate then with direct technique
applied Directly to the patient

Figure 9 Section of intaglio obturator feeding plate after Soft liner application
Fig 10 Obtrutor feeding plate after inserted

DISCUSSION
Babies who suffer from a cleft palate mainly involving the secondary palatum
experience Difficulty breastfeeding because it can not make negative pressure of the
oropharynx by emphasizing the tongue to palate. In such circumstances, breastfeeding in
infants is not recommended, because the baby will choke And can not breathe because of
the return of milk to the nasal cavity. It is recommended to provide milk Using spoons
and glasses made directly into the oropharynx. But this way is certainly not as good
Results obtained if the baby is breastfed directly by the mother. Breastfeeding the baby
directly gives Emotional benefits, nutrition and the establishment of an excellent immune
system from breast milk. Other ways too Can use a special pacifier so that the baby does
not need to suck, but this pacifier Not generally available and hard to
find.Obturatorfeeding plate is one solution that Can be done to solve this problem. 1-3.
Printing a baby's jaw to make an obturator is a challenge in itself The smallness
of the baby's mouth so that it can not use a standard print spoon, anatomical variations
Based on the severity of cleft lip and palate, the possibility of obstruction of the patient's
airway And infants can not follow instructions. 4.5 Ravichandra eta al, 2010 performs
two stages of printing. The first print is done using the bottom of the standard print spoon
and printed material Irreversible hydrocolloid (alginate), the resulting mold is used to
make individual print spoons, Then the second stage of printing is done using an
elastomeric printing material. 4 In this case, The print spoon used is a specially crafted
custom made scoop using resin acrylic. The printed material used is a single-stage
elastomer (Exaflex).
There are several types of material options that can be used to make this obturator,
ie Thermoplastic resin sheets (eg Shellac) and acrylic resins. The advantages of
thermoplastic resin are texture Smooth surface so as to minimize the risk of irritation, but
the thermoplastic resin is less rigid So the increase in the ability to suck is not very good.
Acrylic resin has no texture As smooth as a thermoplastic resin but gives the stiffness
required to suck. 4.5 For the handling of this case, the selected material is acrylic to get
that rigidity Adequate.
 To solve surface texture problems and possible mucosal irritations in the oral
cavity Baby, well-polished obtruator and soft liner on the surface of the intaglion. After
Installation of an obturator, the baby may soon be breastfed by his mother well. Parents
are advised to Using the obturator feeding plate only at the time of feeding to prevent the
obturator being swallowed Or blocking the airway.

CONCLUDE
An important feeding plate obturator is made for cleft lip and palate patients,
especially cracks The ceiling involving the secondary palate, to ensure adequate infant
nutrition intake Can undergo further treatment.

BIBLIOGRAPHY
1. Miloro M. Peterson's principles of oral and maxillofacial surgery. 2 nd Ed. London:
BC Decker Inc.; 2004.p. 838
2. Wray D. Textbook of general and oral surgery. Churchill Livingstone: Elsevier;
2003. p.113
3. Riden K. Key topics in oral and maxillofacial surgery. BIOS Scientific Publishers
Limited; 1998.p.78
4. Ravichandra KS. A new technique of impression making for an obturator in cleft lip
and palate patient. J Indian Soc Pedodont Prev Dent 2010; 4:28, pp 311-14
5. Ravichandra KS. Fabricating feeding plate in CLP infants with two different
materials: A series of case report. J Indian Soc Pedodont Prev Dent 2010 4:30, pp
352-55.