Abida Ijaz.
Management of complete bilateral Cleft of the lip and palate with modified pre Surgical infant Orthopaedic plate.
Pak Oral Dental J Jan ;23(2):131-6.

Cleft of the lip and palate are the most common congenital facial deformities. Clefts may vary in severity from minor notching of the lip or bifid uvula to complete unilateral or bilateral cleft of the lip and palate. Treatment of complete bilateral cleft of the lip and palate had been a challenge in the past, because of protruding pre maxilla and deficient columella. The treatment of choice was excision of pre maxilla, which was later replaced, by surgical retraction of pre maxillary segment alone or the one followed by pre surgical infant orthopedics. The concept of Pre-Surgical Infant Orthopaedics (PSIO) was originated after disappointment from the results of existing techniques. An oral prosthesis, with extra oral attachments around babies head was used to retract pre maxilla. In the following years, this device was modified by making it self retentive by filling the cleft part with acrylic similar to an obturator. In the recent past, however, introduction of soft acrylic has provided retentive means in the defectpart. The device provides alveolar molding maintaining arch form and facilitates function. This article reports on pre surgical infant orthopedic treatment of a new born baby using modified orthopedic plate with anterior acrylic ring. The appliance comprised of an acrylic ring extending anteriorly from the existing orthopaedic plate. The device on insertion surrounded the protruded pre maxilla and exerted retraction force utilizing muscle activity. Acrylic ring was adjusted every fortnight by adding Imm acrylic along the inner surface of the acrylic ring contacting labial surface of pre maxillary segment and trimming the same amount along the anterior margin of the plate. Duration ofappliance wear was three months. The results showed a significant pre maxillary retraction of 3.5mm and correction of rotation by 12 degrees. The appliance proved most successful being used immediately after birth, making use of plasticity of the neonate cartilage due to maternal estrogen levels. Moreover, the appliance maintained arch form, facilitated function and rendered initial lip repaireasy and tension free.

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