Fantastic! With the benefit of our wonderful team of specialists working with you and your baby through BC Children's Hospital, you can expect a great result. See our Graduates section for some amazing photos of our cleft palate patients.
Below is a picture of a cleft palate 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 the general way 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 steristrips and orthodontic elastics
The lip tape 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.
- Impression at the OR 7-14 days of age
- Fit appliance several days later
- Adjust appliance weekly
- Remove wire component just prior to surgery
- Lip repair surgery at approximately 3 months of age
- Acrylic plate to stay in after lip surgery
- Palate surgery at 10-14 months no need for acrylic plates any longer
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!
- Loosening of the plate. Try tightening the elastics by moving the steristrips higher on the plastic skin, or add some denture adhesive to the plate.
- Skin rashes. Try to move the tape or plastic skin to different areas, or if the problems persist, phone the Cleft Clinic at 604-875-3146 and ask to leave a message for Sandra Robertson. She has some great ideas and remedies.
- Sore, red or bleeding areas on the palate or nose. Call the orthodontist to arrange an adjustment.
- Baby pulling plate out! This may happen especially later in treatment, it is important to keep the plate in if at all possible. Use more denture adhesive, put mitts or socks on the hands. If the plate is left out the tongue can push up into the cleft possibly widening the cleft in the palate and therefore making the palate surgery more difficult and prone to complications.
- Plate not fitting because of teeth coming in. Call the orthodontists office to have the plate adjusted.
Orthodontics is a branch of dentistry that specializes in the diagnosis, prevention, and treatment of dental and facial irregularities.
An orthodontist is a dentist who specializes in braces for both children and adults. Orthodontists have completed dental school, just as your family dentist, but have also had additional training (called a residency) for an additional 2 to 3 years. During their residency the orthodontist learns not only about placing braces on teeth but also studies the growth and development of the jaws. From their background, orthodontists can determine developing bite problems at very early ages.
- A more attractive smile
- Reduced appearance-consciousness during critical development years
- Better function of the teeth
- Possible increase in self-confidence
- Increased ability to clean the teeth
- Improved force distribution and wear patterns of the teeth
- Better long term health of teeth and gums
- Guide permanent teeth into more favorable positions
- Reduce the risk of injury to protruded front teeth
- Aid in optimizing other dental treatment