Orthodontic Appliance-Related Mucosal Ulcerations in Newborns and Infants With Craniofacial Disorders

In craniofacial disorders (CD) like cleft lip and/or palate (CL/P), Robin sequence (RS) or Down syndrome (DS), an early orthodontic intervention with different palatal plate devices is often applied. However, there are no data on complications such as mucosal ulcerations (MU).To determine the frequency and location of MU and evaluate associations with potential risk factors such as CD type, sex, appliance type, cleft location, underlying syndrome, and anatomical cleft morphology.

In a retrospective analysis, we searched our electronic patient records of newborn patients with CD admitted 01/2020-12/2022 for documented MU. For comparisons, Pearson's Chi-square or Fisher's Exact test were used, statistical significance was set at p < 0.05.

A total of 248 patients (132 female, age range: 0-580 days) receiving 510 palatal plates were treated (51% CL/P, 26% RS; 24% DS); 81/248 (33%) infants had MU, occurring with 112/510 appliances (22%). MU were most common in RS patients (61/69; 88%), followed by CL/P (21/111; 19%). No MU were found in DS. MU occurrence differed significantly by type of orthodontic palatal plate (p < 0.0001). There was no significant association between sex, cleft location, presence of an underlying syndrome or cleft morphology and the occurrence of MU.

MU are common during palatal plate therapy. Our findings suggest that MU are correlated with both, the device's function and the mucosal load it applies. Parental training in device use and oral inspection, along with regular clinical check-ups, is advised to identify MU early, increase appliance quality and patient comfort.