A Pristine Approach for the Prominent Premaxilla in Bilateral Cleft Lip and Palate (BCLP) Cases

The neonate premaxilla in bilateral cleft lip and palate is often protruding and displaced laterally. Surgeons prefer the premaxilla to be repositioned and centralized to allow a tension-free primary lip repair. This report describes the fabrication of a premaxillary bonnet appliance with silicone material and its successful use in 2 cases of bilateral cleft lip and palate (BCLP).

Two male BCLP patients of ages 34 days and 10 days, respectively.

Nonsurgical repositioning of the premaxillary segment using silicone cup-bonnet appliance.

The duration of active treatment by silicone appliance was 36 days in case 1 and 75 days in case 2. The retention period was 2 months and 3 months, respectively. The appliance made of room temperature vulcanizing (RTV) silicone is flexible and softer in comparison to the rigid conventional acrylic appliance and is therefore almost atraumatic. A gentler appliance resulted in enhanced compliance and acceptance by the neonates. There was a noticeable change in the position of the discernible asymmetric premaxilla. Analysis of frontal facial photographs revealed an angular change in the position of the premaxilla (C) by 12° in case 1 and 6° in case 2 in reference to the midfacial plane.

This silicone appliance provides enhanced compliance and improved retention compared to acrylic appliance since it is a more gentle, flexible, and less traumatic alternative to a rigid acrylic appliance. Further, the RTV silicone appliance can be 3-dimensionally printed for better accuracy following intraoral scanning and thus eliminating the need for impression making in cleft newborns.