[Cleft palate prosthesis: hard palate obturator].
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The restoration of the soft palate presents a challenge completely different from that of the hard palate. The mobility of the soft palate tends to interfere with velar extensions. The reduction in size of the soft palate extension to prevent impingement upon the mobile margins of the defect will lead to insufficient oronasal separation during functional activities. The solution is to construct a specially designed prosthesis to attain the maximum utilization of the remaining structures and their motility. Although each pharyngeal extension is different in shape, they give the patient an effective functional mechanism that enhances speech and swallowing.
It appears that the palatal lift prosthesis is an effective prosthesis to improve palatopharyngeal incompetence in selected patients. Despite the inconvenience and problems associated with a prosthesis, this procedure is indicated for selected patients who have anatomically normal palates that are dysfunctional. The ultimate benefit of the palatal lift prostheses to the speech of the patients is not the subject of this report. However, it should be noted that many patients can benefit from speech therapy after a satisfactory prosthetic result has been achieved.
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Ten of 11 patients who developed oronasal fistulae subsequent to palatoplasty and/or pharyngeal flap operation obtained complete physiological closure of the fistula by using a vinyl palatal appliance for a two to three month period. All these fistulae were diagnosed within 10 days to two weeks after the surgery, and the appliance therapy was started immediately. We believe this treatment to be an effective, uncomplicated method for non-surgical closure of recent postoperative oronasal fistulae.
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Primary veloplasty during the first year of life enables normal growth of the upper jaw and of the facial skeleton in patients with clefts. In spite of the remaining cleft in the hard palate, intelligible speech can be learned. The closure of the residual cleft of the hard palate is generally postponed until the age of 12 to 14 years, when the normal growth of the jaw is virtually completed. This method has been used in the clinic by the author and his father for thirty years. The results after primary veloplasty for some hundred adult patients show normal maxillary and cranial growth both clinically and radiologically. Primary veloplasty operations constitute acceptable restorative surgical treatment of the maxilla. Various problems of timing and methods of cleft palate treatment are discussed. The author's cases are summarized.
The diagnosis and treatment planning for palatopharyngeal incompetency is such that decisions can best be arrived at following a qualified interdisciplinary team assessment. The pedodontist, as an integral member of a rehabilitation team, should be knowledgeable in the area of speech prostheses for the child patient. It is only through an increased knowledge and understanding of current surgical and prosthetic techniques that patients with palatopharyngeal incompetency can receive better treatment.
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