Chapter 8: Presurgical Orthopaedics

'Orthopaedics' is a word derived from two Greek words that literally mean 'straight child'. Similarly, 'orthodontics' means 'straight teeth'. Orthopaedics usually refers to some form of physical or surgical treatment to correct deformities affecting bones, muscles and joints. The term 'presurgical orthopaedics' is often used to describe the treatment with an 'obturator plate' and strapping across the lip and nose of a baby who has complete unilateral or bilateral clefts of the lip and palate.

Although the obturator plate is frequently called a sucking or feeding appliance, this is intended to do more than simply make sucking easier, as the term 'obturate' means 'closing over'. The plate covers over the gaps left by the cleft(s) of the gum pad, thus preventing the baby's tongue and the feeding teat from pushing into the cleft space. The plate provides a moulding (orthopaedic) effect on the cleft gum pad which helps to reduce the size of the cleft in the mouth before surgery. In addition, the plate helps the baby to hold the tip of the tongue in a more normal position. Most speech pathologists believe that this helps later speech development. The plate has to be worn full time by the baby for it to be successful.

The baby's favourable adaptation to the plate depends on it being fitted within a few days of birth, as well as on the parent's capacity to manage the extra work of fitting, removing and cleaning it. Although it is best fitted early, the plate can be fitted to a baby as old as one month. The plate will need occasional adjustment and possible replacement when the baby's upper gum pad grows and changes shape.

The design of the feeding appliance and the application of elastic strapping to the central part of the upper lip and nose (columella) varies, but the objectives of the presurgical treatment are the same for all. It is desirable for the baby to have the plate while the strapping is applied, because the strapping by itself tends to produce too much contraction of the upper gum pad, which will lead later to a more narrow upper dental arch.

An orthodontist from the Cleft Palate Clinic will usually be called on by your paediatrician to provide presurgical orthopaedics.

Further Information

To obtain further information on "Cleft Lip and Palate: A Parent's Guide", please contact Belinda Liston:

Belina Liston
Cleft Palate Clinic Coordinator
The Cleft Palate Clinic
The Children's Hospital at Westmead
Locked Bag 4001
WESTMEAD NSW 2145
AUSTRALIA
T: + 61 2 9845 2079
F: + 61 2 9845 2078
E: BelindaS4@chw.edu.au