Below is a picture of a cleft palete appliance. It is called a Nasal Stint and the design can vary depending on whether the cleft is single (Unilateral) or double (Bilateral). This is a Bilateral Nasal Stint.
Below is a picture of a baby with a bilateral cleft lip and palate with all of the tapping in place, it looks really complicated but don't worry we will lead you through the process step by step.
The following diagrams show in general the way in which appliances work in a bilateral case followed by a unilateral case.
The measuring of your baby and the manufacture and fitting of the appliance will be performed by Dr. Pocock. An impression or mould will need to be taken, this is usually done when the baby is 7-14 days old and this procedure is most frequently performed by your Orthodontist in the Operating Room (OR) with an Anaesthetist "standing by". Your baby will not be anaesthetised, the Anaesthetist is just there to monitor your baby and help with breathing if there is a concern. This however is very unlikely, we just want to be as careful as possible. Our nurse practitioner or the Anaesthetist will advise you as to when your baby's last feed before the procedure is to occur.
Once the baby is returned to you after about 15 - 30 minutes you may feed him. At this stage you will be given an appointment at your orthodontist's office for the fitting of the appliance usually within a couple of days. The rest of the adjustment appointments will occur at the orthodontist's office.
A plaster cast is made from the impression and then a technician will fabricate the appliance.
At the Orthodontist's office the appliance will be fitted and you will be given instructions on how to place and remove it including how to use the various tapes and elastics.
Below shows the plastic skin or base tape that is fitted to the cheeks.
Below shows the steristrips and orthodontic elastics
The lip tape it must be placed very tightly—ideally the lip will blanch (look white)
Sometimes denture adhesive is used help the appliance stay secure
- Clean the appliance and palate at least once per day
- Change the lip tape several times a day making sure to keep pressure on the lip and underlying tissue
- Change the base tape and steristrips as needed. The base tape can be left on for up to a week before changing it. This protects the cheeks from the more frequent changing of the lip tape and steristrips.
Photos will be taken and a copy will be given to you for your records. Sometimes the completed appliance will be delivered at this time, while in other cases the rest of the appliance will be fitted a week following. Adjustment appointments will then usually occur at weekly intervals, sometimes longer especially for out of town patients.
Babies with bilateral clefts will have some additional modifications to the appliance and taping made at about 6 weeks.
Just prior to surgery the wire component will be removed but the acrylic plate will stay in until the palate surgery at between 10 -14 months.
Babies get used to these appliances quite quickly, it will surprise you how adaptable they are, also you will see improvements in appearance almost immediately. Although you will feel "all thumbs" to begin with it will soon become routine and very rewarding as you see the fruits of your labours in the permanent improvement you have helped make in your babies appearance!
