Custom-Made Palatal Shield Use in Cleft Palate and Fistula Repair

Abstract

Objective:

To review our experience with a polymethylmethacrylate (PMMA) protective shield used as an adjunct to protect the newly restored palate in wide bilateral cleft and complex fistula closure without diet restrictions.

Design:

Clinical cohort study.

Setting:

Division of Plastic Surgery and Maxillary Surgery.

Patients:

A selection of 22 cleft palate children undergoing (tertiary) palatal fistula repair (n = 16) or closure of a complex wide primary palatal defect (n = 6).

Interventions:

One month prior to surgery, a plaster model of the palate was made adding a 5- to 8-mm-thick layer of dental putty to the level of the dental arch. On top of the putty, a 1.5-mm-thick PMMA shield was created to cover the postoperative elevated and restored palate.

Main outcome measures:

Fistula recurrence rate, postoperative complications, days of hospitalization.

Results:

All patients maintained durable and safe palatal closure without fistula recurrence within the follow-up period, varying from 1 until 4 years. Recovery was fast, with a mean duration of hospitalization of 1.5 days. All patients could directly resume their normal diet.

Conclusions:

A PMMA shield has been shown to be a safe and helpful adjunct in complex fistula repair and late anterior palate repair.