Modified intraoral prosthetic appliance to retract protruded premaxillae and prolabium in babies with bilateral cleft lip and palate [BCLP]

Management of the protruded and rotated premaxilla and prolabium in patients with bilateral cleft lip and palate [BCLP] presents a challenging problem for the reconstructive team. Prosthetic intervention to retract a protruded premaxilla before surgical correction may improve the bony base for tissue molding, avoid excess tension at the surgical site and permitting a one-stage surgical repair. An extraoral and intraoral prosthetic appliance has been used to move the premaxilla and prolabium to a more favorable position. Resilient denture liners were used to cover the part of the elastomeric chain covering the prolabium in intraoral appliances. These liners always need frequent replacement due to lost resiliency, irritation to the skin and their contamination with nasal discharges and sweet. The aim of this study is to improve this design of an intraoral traction appliance to align the protruding premaxilla in infants with bilateral cleft lip and palate. Five babies were selected for this study from pediatric clinic -Tanta University. Their age ranged from 2-10 months. All the babies had bilateral cleft lip and palate. Silicone rubber impressions were made, palatal base plate was constructed using light-cured resin, and two orthodontic buttons were placed in the middle alveolar ridge area of the plate medial to the alveolar crest. A flat rubber tube was cut nearly the same size of the prolabium, the elastomeric chain was passed through this part of the rubber tube. Using a flat rubber tube instead of resilient denture liner is non- irritant to the skin, easy to clean and allows a free movement of the elastomeric chain