Oral Rehabilitation of patient with Cleft Lip and Palate- A Case Report

Cleft lip and palate (CLP) is the most common congenital facial anomaly. About 70% of all the CLP cases and 50% of cleft palate only fall within non-syndromic pathologies. The purpose of this report was to show the clinical management of initial obturator therapy from birth to 3 months. The obturator was fabricated from the conventional orthodontic acrylic materials with cold polymerization (OrtoPoli, Polident, Slovenia). For successful treatment of cleft lip and palate patients, during the planning of prosthetic therapy one should take into consideration the deformation of maxillary segments\, as well as the disproportion between the upper and lower jaw alveolar ridge. Well planned prosthetic therapy will result in satisfactory function and aesthetics of a cleft palate patient. Case Report Oral Rehabilitation of patient with Cleft Lip and PalateA Case Report Vesna Ambarkova1*, Biljana Djipunova2, Manu Batra3 and Slagana Trajkova4 1Research Fellow PhD, MSc, DDS, University St. Cyril and Methodius, Faculty of Dental Medicine, Department of Paediatric and Preventive Dentistry, Skopje, Republic of Macedonia 2Associate Professor, PhD, MSc, DDS, University St. Cyril and Methodius, Faculty of Dental Medicine, Department of orthodontics, Skopje, Republic of Macedonia 3Senior Lecturer,MDS,BDS, Department of Public Health Dentistry, Surendera Dental College & Research Institute, Sri Ganganagar, Rajasthan, India 4Logoped, Institute for Rehabilitation of Hearing, Speech and Voice, Skopje, Republic of Macedonia Dates: Received: 12 September, 2017; Accepted: 12 October, 2017; Published: 13 October, 2017 *Corresponding author: Vesna Ambarkova PhD, MSc, DDS, University St. Cyril and Methodius, Faculty of Dental Medicine, Department of Paediatric and Preventive Dentistry, Vodnjanska 17 University Dental Clinic Center Sv.Pantelejmon Skopje 1000 , Republic of Macedonia, Tel: ++38970686333; E-mail:


Introduction
Cleft lip and palate (CLP) is the most common congenital facial anomaly. Its incidence varies according to epidemiologic studies but is usually between 1 and 1.82 for each 1000 births [1]. CLP is a congenital deformity that is associated with maxillary sagital and transverse discrepancies [2,3]. In addition to skeletal discrepancies; this deformity is often accompanied by dental abnormalities, such as hypodontia, hyperdontia, and transpositions [4,5].
About 70% of all the CL/P cases and 50% of cleft palate only fall within non-syndromic pathologies. All the other cases are linked to cardiac, limb, ophthalmological syndromes and other. The manifestation of the disease (syndromic and nonsyndromic) have been linked to some defects of grow factors and their receptors [6], such as FGF8 and FGFR1 genes. TGF is another family gene involved in the formation of the oral cleft, in particular: TGF3, with the inactivation of its receptor TGF3R2 [7], and the inactivation of BMP7 [8,9]. CLP patients might suffer from unfavourable smile aesthetics and low self-esteem, leading mainly to diffi culties in social interactions. The treatment for patients with CLP is challenging because of the diffi culties inherent in the deformity, the necessity of interdisciplinary involvement, and the need for good patient cooperation. The results might still be limited even if all of these challenges can be overcome [10].
The purpose of this report was to show the clinical management of initial obturator therapy from birth to 3 months.

Case Report
Baby with female gender and diagnosis Cheilognathopalatoschisis was one and half month when her mother and her grandparents come to the Department for preventive and pediatric dentistry and Department for orthodontics, University Dental Clinic Centar-Skopje ( Figure   1). They were sent to our department from the University Clinic for facial, jaws and neck surgery. Girl was the fi rstborn of related, healthy young parents with an unmarkable family history. Baby was born after a normal pregnancy by caesarean section at the 37 th gestational week and delivery with birth weight 2060 gr and body length 45 cm. Apgar score was 8/9 at 5/10 minutes, respectively. During the visit of department, the baby was accompanied by the mother and grandparents.
The parents were young and of Gipsy origin and without proper medical documentation. The mother is younger than 18 years old. Her pregnancy was ended by caesarean section at the 37 th gestational week. The mother was born in Podujevo, Republic of Kosovo and along with her juvenile daughter have been granted legal asylum for humanitarian or subsidiary protection. Model has to be place in a warm, moist environment to cure for 20 minutes. Clinical doctor have to add autopolymerizing acrilic resin to the palate using a "salt and pepper" method, making sure the acrylic resin extends well into the mucobuccal fold area. In the fi nal stage the appliance was trimmed and polished ( Figure 5). The mother and grandparents were told to wait several hours, and the obturator was given and placed on the baby's mouth the same day ( Figure 6).     that the width is due to a palate-alveolar hypoplasia [11,12].
In unilateral cleft lip and palate, the orbicularis muscle

Pediatric problems of cleft lip and palate
Based on previous research it has been established that children with clefts of lip and palate are more susceptible to some diseases than children without them.

Nutrition
The fi rst problem occurs as soon as the baby is born when it needs to be fed. These babies cannot suck, because they are not  In our case report, parents relatively late brought their baby to make an acrylic orthodontic device, mostly and probably because they did not have proper medical documents.
As far as pre-surgical orthopedic therapy is concerned, there are contradictory opinions:Тhе opponents believe that primary surgery should give an anatomical basis for orthodontic therapy, not vice versa. However, often the scar tissue that remains after surgery precisely prevents normal maxilla growth.
The supporters highlight the following benefi ts: • bringing maxillary segments into a better position for each other • narrowing the split and reducing tissue defi ciency helps feed, and therefore the progression of the baby

Conclusion
The effect of infant orthopaedics on maxillary arch has been a subject of debate for many years, but controversy about justifi cation of the use of the nasoalveolar molding appliance still exists. Advocates of infant orthopaedics claim that the presurgical orthopaedic plate molds the alveolar segments into a better arch form and that with this action the dentomaxillary development would be improved [13,14]. Opponents of this therapy claim that lip surgery alone has the same effect and that presurgical orthopedic plate is only an expensive appliance used to comfort the parents by starting treatment at the earliest possible moment [15,16]. the For successful treatment of cleft lip and palate patients, during the planning of prosthetic therapy one should take into consideration the deformation of maxillary segments, eventually residual palatal defects, as well as the disproportion between the upper and lower jaw alveolar ridge. Well planned prosthetic therapy will result in satisfactory function and aesthetics of a cleft palate patient.