Palatal obturator

Last updated
The Latham Device Pre Latham Device.jpg
The Latham Device
Post Latham Post Latham Device.jpg
Post Latham
Nasal Alveolar Molding Device Nasoalveolar.jpg
Nasal Alveolar Molding Device
Post Insertion Post Nasal Alveolar Molding.jpg
Post Insertion

A palatal obturator is a prosthesis that totally occludes an opening such as an oronasal fistula (in the roof of the mouth). They are similar to dental retainers, but without the front wire. Palatal obturators are typically short-term prosthetics used to close defects of the hard/soft palate that may affect speech production or cause nasal regurgitation during feeding. Following surgery, there may remain a residual orinasal opening on the palate, alveolar ridge, or vestibule of the larynx. A palatal obturator may be used to compensate for hypernasality and to aid in speech therapy targeting correction of compensatory articulation caused by the cleft palate. In simpler terms, a palatal obturator covers any fistulas (or "holes") in the roof of the mouth that lead to the nasal cavity, providing the wearer with a plastic/acrylic, removable roof of the mouth, which aids in speech, eating, and proper air flow.

Contents

Palatal obturators are not to be confused with palatal lifts or other prosthetic devices. A palatal obturator may be used in cases of a deficiency in tissue, when a remaining opening in the palate occurs. In some cases it may be downsized gradually so that tissue can strengthen over time and compensate for the decreasing size of the obturator. The palatal lift however, is used when there is not enough palatal movement. It raises the palate and reduces the range of movement necessary to provide adequate closure to separate the nasal cavity from the oral cavity. Speech bulbs and palatal lifts aid in velopharyngeal closure and do not obturate a fistula. A speech bulb, yet another type of prosthetic device often confused with a palatal obturator, contains a pharyngeal section, which goes behind the soft palate.

Palatal obturators are needed by individuals with cleft palate, those who have had tumors removed or have had traumatic injuries to their palate.

Types of palatal obturators

A palatal plate is a prosthetic device, generally consisting of an acrylic plate and retention clasps of orthodontic wire, which covers a fistula of the palate. It may be used to aid in improving articulation and feeding. The blockage of the opening helps improve hypernasality and suckling ability for babies. In the case of a labial-oral-nasal fistula, the plate may include an anterior upward extension to fully occlude the passageway running between the labial surface of the alveolus, alveolus, and nasal cavity. The plate may be constructed to include any congenitally missing teeth to improve articulation and appearance. Individuals who use palatal plates must be monitored periodically by their dental professionals due to possible tissue irritation by the plate. Materials such as food particles, oral mucosa and secretions may cause buildup on the upper surface of the plate; therefore, it is essential to clean a palatal obturator at least twice a day to avoid tissue irritation. There are also more specific terms used for obturators depending on their time and purpose of use: Photo Examples of the Latham Device or the Nasal Alveolar are prime examples for use in Cleft Palate Deformities.

Palatal adhesives are oral adhesives or skin barrier materials used to occlude a fistula of the hard palate. Obturators of this type must be removed before eating and drinking. Users must cut the new piece of adhesive and hold it over the fistula until it adheres. Adhesives are not to be used for soft palate fistulae if the soft palate has some mobility due to possible unintentional dislodging and digestion of the material.

The Nance Obturator

This fixed obturator is based on the Nance appliance, which was originally used as a space maintainer in dentistry and orthodontics, but has been redesigned for closing anterior palatal fistulas in patients with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful.

Speech

Often a palatal obturator is used because a palatal fistula can affect development and proper articulation. As fistula sizes vary, small fistulae tend to result in little to no speech alterations whereas large fistulae tend to result in audible nasal emissions and weak pressure with and/or without hypernasality. Misarticulations, abnormal nasal resonance and nasal escape or air often results from the problem. Fistulae may decrease intraoral air pressure during production of oral pressure consonants causing distortion of sounds as well as increase in nasal airflow. It is common for an individual with a fistula to compensate for a loss of pressure during speech sound production by attempting to regulate intraoral air pressure with increasing respiration effort and using compensatory articulation. Middorsum palatal stops (atypical place of articulation) often results from palatal fistulae causing sound distortions during speech. Occlusion for the fistula is attempted by speakers with deviant tongue placements during these palatal stops.

The palatal obturation may be managed temporarily or may be sustained for longer periods of time. Location-specific palatal obturation has been documented to significantly improve articulation errors, hypernasality (based on listener judgments), and nasal emissions (immediately post-obturation only). Usage of more anterior tongue placements is considered a primary target for speech therapy. The relationship between palatal openings and articulation is important to note prior to surgical plans to ascertain timing of speech therapy and most appropriate therapy goals and approach. Speech therapy may be most beneficial prior to sustained palatal obturation rather than short-term obturation.

See also

Related Research Articles

The field of articulatory phonetics is a subfield of phonetics that studies articulation and ways that humans produce speech. Articulatory phoneticians explain how humans produce speech sounds via the interaction of different physiological structures. Generally, articulatory phonetics is concerned with the transformation of aerodynamic energy into acoustic energy. Aerodynamic energy refers to the airflow through the vocal tract. Its potential form is air pressure; its kinetic form is the actual dynamic airflow. Acoustic energy is variation in the air pressure that can be represented as sound waves, which are then perceived by the human auditory system as sound.

<span class="mw-page-title-main">Cleft lip and cleft palate</span> Birth defect of the palate and upper lip

A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate contains an opening into the nose. The term orofacial cleft refers to either condition or to both occurring together. These disorders can result in feeding problems, speech problems, hearing problems, and frequent ear infections. Less than half the time the condition is associated with other disorders.

<span class="mw-page-title-main">Soft palate</span> Flexible part of maxilla

The soft palate is, in mammals, the soft tissue constituting the back of the roof of the mouth. The soft palate is part of the palate of the mouth; the other part is the hard palate. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone.

Prosthodontics, also known as dental prosthetics or prosthetic dentistry, is the area of dentistry that focuses on dental prostheses. It is one of 12 dental specialties recognized by the American Dental Association (ADA), Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of Ireland, Royal College of Surgeons of Glasgow, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons. The ADA defines it as "the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth or oral and maxillofacial tissues using biocompatible substitutes."

Inflammatory papillary hyperplasia (IPH) is a benign lesion of the oral mucosa which is characterized by the growth of one or more nodular lesions, measuring about 2mm or less. The lesion almost exclusively involves the hard palate, and in rare instances, it also has been seen on the mandible. The lesion is mostly asymptomatic and color of the mucosa may vary from pink to red.

<span class="mw-page-title-main">Palatal lift prosthesis</span>

A palatal lift prosthesis is a prosthesis that addresses a condition referred to as palatopharyngeal incompetence. Palatopharyngeal incompetence broadly refers to a muscular inability to sufficiently close the port between the nasopharynx and oropharynx during speech and/or swallowing. An inability to adequately close the palatopharyngeal port during speech results in hypernasalance that, depending upon its severity, can render speakers difficult to understand or unintelligible. The potential for compromised intelligibility secondary to hypernasalance is underscored when consideration is given to the fact that only three English language phonemes – /m/, /n/, and /ng/ – are pronounced with an open palatopharyngeal port. Furthermore, an impaired ability to effect a closure of the palatopharyngeal port while swallowing can result in the nasopharyngeal regurgitation of liquid or solid boluses.

<span class="mw-page-title-main">Pierre Robin sequence</span> Medical condition

Pierre Robin sequence is a congenital defect observed in humans which is characterized by facial abnormalities. The three main features are micrognathia, which causes glossoptosis, which in turn causes breathing problems due to obstruction of the upper airway. A wide, U-shaped cleft palate is commonly also present. PRS is not merely a syndrome, but rather it is a sequence—a series of specific developmental malformations which can be attributed to a single cause.

<span class="mw-page-title-main">Augmentation pharyngoplasty</span>

Augmentation pharyngoplasty is a kind of plastic surgery for the pharynx when the tissue at the back of the mouth is not able to close properly. It is typically used to correct speech problems in children with cleft palate. It may also be used to correct problems from a tonsillectomy or because of degenerative diseases. After the surgery, patients have an easier time pronouncing certain sounds, such as 'p' and 't', and the voice may have a less nasal sound.

Vomer flap surgery was used prior to 1975 as a surgical treatment for children with cleft palate. In this procedure, the vomer bone was used to reconstruct the palate and cover the cleft.

Pharyngeal flap surgery is a procedure to correct the airflow during speech. The procedure is common among people with cleft palate and some types of dysarthria.

Velopharyngeal insufficiency is a disorder of structure that causes a failure of the velum to close against the posterior pharyngeal wall during speech in order to close off the nasal cavity during oral speech production. This is important because speech requires sound from the vocal folds and airflow from the lungs to be directed into the oral cavity (mouth) for the production of all speech sounds, with the exception of nasal consonants. If complete closure does not occur during speech, this can cause hypernasality and/or audible nasal emission during speech. In addition, there may be inadequate airflow to produce most consonants, making them sound weak or omitted.

Restorative dentistry is the study, diagnosis and integrated management of diseases of the teeth and their supporting structures and the rehabilitation of the dentition to functional and aesthetic requirements of the individual. Restorative dentistry encompasses the dental specialties of endodontics, periodontics and prosthodontics and its foundation is based upon how these interact in cases requiring multifaceted care. This may require the close input from other dental specialties such as orthodontics, paediatric dentistry and special care dentistry, as well as surgical specialties such as oral and maxillofacial surgery.

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

<span class="mw-page-title-main">Jaw abnormality</span> Medical condition

A jaw abnormality is a disorder in the formation, shape and/or size of the jaw. In general abnormalities arise within the jaw when there is a disturbance or fault in the fusion of the mandibular processes. The mandible in particular has the most differential typical growth anomalies than any other bone in the human skeleton. This is due to variants in the complex symmetrical growth pattern which formulates the mandible.

Orofacial myofunctional disorders (OMD) are muscle disorders of the face, mouth, lips, or jaw due to chronic mouth breathing.

<span class="mw-page-title-main">Dental prosthesis</span> Intraoral device for reconstructing missing teeth

A dental prosthesis is an intraoral prosthesis used to restore (reconstruct) intraoral defects such as missing teeth, missing parts of teeth, and missing soft or hard structures of the jaw and palate. Prosthodontics is the dental specialty that focuses on dental prostheses. Such prostheses are used to rehabilitate mastication (chewing), improve aesthetics, and aid speech. A dental prosthesis may be held in place by connecting to teeth or dental implants, by suction, or by being held passively by surrounding muscles. Like other types of prostheses, they can either be fixed permanently or removable; fixed prosthodontics and removable dentures are made in many variations. Permanently fixed dental prostheses use dental adhesive or screws, to attach to teeth or dental implants. Removal prostheses may use friction against parallel hard surfaces and undercuts of adjacent teeth or dental implants, suction using the mucous retention, and by exploiting the surrounding muscles and anatomical contours of the jaw to passively hold in place.

<span class="mw-page-title-main">Hypernasal speech</span> Abnormal vocal sound due to excess airflow through the nose during speech

Hypernasal speech is a disorder that causes abnormal resonance in a human's voice due to increased airflow through the nose during speech. It is caused by an open nasal cavity resulting from an incomplete closure of the soft palate and/or velopharyngeal sphincter. In normal speech, nasality is referred to as nasalization and is a linguistic category that can apply to vowels or consonants in a specific language. The primary underlying physical variable determining the degree of nasality in normal speech is the opening and closing of a velopharyngeal passageway between the oral vocal tract and the nasal vocal tract. In the normal vocal tract anatomy, this opening is controlled by lowering and raising the velum or soft palate, to open or close, respectively, the velopharyngeal passageway.

<span class="mw-page-title-main">Velopharyngeal consonant</span>

The velopharyngeal fricatives, also known as the posterior nasal fricatives, are a family of sounds sound produced by some children with speech disorders, including some with a cleft palate, as a substitute for sibilants, which cannot be produced with a cleft palate. It results from "the approximation but inadequate closure of the upper border of the velum and the posterior pharyngeal wall." To produce a velopharyngeal fricative, the soft palate approaches the pharyngeal wall and narrows the velopharyngeal port, such that the restricted port creates fricative turbulence in air forced through it into the nasal cavity. The articulation may be aided by a posterior positioning of the tongue and may involve velar flutter.

<span class="mw-page-title-main">Alveolar cleft grafting</span> Surgical procedure

Alveolar cleft grafting is a surgical procedure, used to repair the defect in the upper jaw that is associated with cleft lip and palate, where the bone defect is filled with bone or bone substitute, and any holes between the mouth and the nose are closed.

References