A Postsurgical Obturator after Cleft Lip Repair in Patients with Holoprosencephaly

Abstract

Several factors affect healing of lip repair in children with complete cleft lip and palate in the immediate postoperative period. However, children with holoprosencephaly present a unique challenge. Because of their wide midline clefts and premaxillary agenesis they have protrusive positioning of their tongue, which can adversely affect the surgical result. In these cases we have found a postsurgical obturator made with hard-setting acrylic to be especially useful. Such an appliance may be used for the initial healing period (1-2 weeks). Two cases are presented here where such a device was used successfully.

Presurgical Orthodontic Therapy in a Newborn With Median Cleft Lip Accompanied by Holoprosencephaly and Agenesis of the Premaxilla

“…Unlike the previously described apparatuses that are inserted at about three months of age when the reparation of the lips is performed and when they serve only to prevent the damage to the surgical site by premature removal of the sutures [17], the RBJ stimulator significantly reduces the width of the cleft to the very Posterior cleft width on the level of T and T' 14.56 6.47 moment of surgery. In addition, when inserted during the operation, it also participates in the prevention of violation of the suture integrity, as it prevents the interposition of the tongue, as stated by Acharia et al [14] Furthermore, the early appliance of the RBJ apparatus as well as its constant carrying until the surgery has affected the tongue position and has brought the tongue position to the level of the lower jaw to a certain extent.…”

“…Excellent retention of the apparatus is achieved only by immaculate impression taking, which is described in this paper. We consider that the retention of the RBJ apparatus is more comfortable for the patient, as opposed to the different ways of apparatus retaining, which are described in the literature as: by placing two bone screws in the mid-facial area (titanium 2.0x8 mm through the palatal holes) [14].…”

Alobar holoprosencephaly: a case report

“…Later, the baby will be fitted with an arm restraint device to prevent damage to the area of the surgery site on the lips due to the baby's arm accidentally damaging it. 15 This study's limitation is that we only did some initial and supportive care to the patient and her baby but did not follow up until the end.…”