Cleft palate orthopedics: Why, when, how

Abstract

C l e f t palate orthopedics is usually referred to as the neonatal repositioning of the maxillary bony segments, thereby obtaining a more nearly normal skeletal base under the lip and nose. I prefer to think of cleft palate orthopedics as any therapy applied to the neonatal maxilla that can restore the maxilla and the oral and nasal cavities to a more norml functional relationship. Since Kjellgren ~ and McNeil 2 first introduced these techniques in the early 1950's they have been widely discussed by many supporters and by an equal number of detractors. Supporters feel that cleft palate orthopedics can control and modify the postnatal development of the maxilla, 3 stimulate palatal shelf growth/ and aid the plastic surgeon2 Its detractors claim that too much clinical time is required in relation to the benefits obtained and that treatment is too complex to be performed except in special clinics/' I maintained that the techniques I employ in case analysis and appliance construction eliminate lengthy procedures and make cleft palate orthopedics a practical procedure. Cleft palate orthopedics can yield many benefits. Specifically, orthopedic appliances can aid nursing, stimulate oral-facial development, develop the palatal shelves, prevent tongue distortions, prevent nasal septum irritation, decrease the number of ear infections, expand collapsed maxillary segments, constrict the expanded anterior part of the maxilla, reposition the premaxilla, aid the plastic surgeon, and help the mother psychologically. Any one of these factors alone may be compelling enough to warrant therapy. Most often, however, it is a combination of several factors that influence my decision to construct an orthopedic feeding appliance for a child.