Submitted:
04 September 2026
Posted:
07 September 2026
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Abstract
Background: Infants with cleft lip and palate may experience substantial feeding difficulty because the palatal defect prevents effective separation of the oral and nasal cavities. Feeding obturators are removable prosthetic appliances that cover the palatal cleft and may provide a firm surface against which a feeding nipple can be compressed. Obtaining an accurate maxillary impression in a young infant is technically demanding because of the small oral cavity, limited cooperation, cleft undercuts, and potential airway-related risks associated with impression material. Case presentation: A 6-month-old male infant with unrepaired complete right unilateral cleft lip and palate presented with difficulty feeding and drinking milk. A feeding obturator was planned as an adjunct to feeding management. Because the infant could not sit independently in the dental chair, his mother sat in the dental chair and supported him on her lap. The cleft region was blocked out before impression making, and alginate was used to record the maxillary arch and palatal defect. Impression making was difficult because of crying, movement, and limited cooperation, and approximately four to five attempts were required before a clinically acceptable impression was obtained. A working cast was prepared, and a feeding obturator was fabricated using conventional hard acrylic resin. The appliance was finished, polished, adjusted, and delivered with caregiver instructions. At the 2-week follow-up, the mother reported easier milk intake, reduced nasal leakage, and shorter feeding time. The appliance remained stable, and no oral ulceration was observed. Conclusion: Impression making for a feeding obturator in an infant with cleft lip and palate requires careful control of impression material and close attention to patient positioning and airway safety. In this case, a conventional acrylic feeding obturator was associated with caregiver-reported short-term improvement in feeding and reduced nasal leakage without observed mucosal ulceration.
Keywords:
cleft lip and palate
; feeding obturator
; feeding plate
; infant
; alginate impression
; palatal obturator
; maxillofacial prosthodontics
; case report
Introduction
Cleft lip with or without cleft palate is a common congenital craniofacial anomaly and may affect feeding, speech, hearing, dentofacial development, and facial appearance. During infancy, feeding is often among the earliest functional concerns because a palatal cleft creates communication between the oral and nasal cavities and may interfere with generation of the pressure differential required for effective sucking [1,2,3].
Feeding support for infants with cleft palate may include caregiver education, positioning strategies, specialized bottles or nipples, squeezable feeding systems, and, in selected cases, a maxillary feeding plate or obturator [2,3,4,5]. Current evidence does not establish a single feeding intervention as superior for every infant; therefore, management should be individualized according to cleft anatomy, feeding performance, available resources, and multidisciplinary assessment [2,3].
A feeding obturator is a removable prosthetic appliance that covers the palatal defect and provides a relatively rigid surface against which the nipple may be compressed. It may also reduce direct passage of milk into the nasal cavity [3,4,5,6,7]. Fabrication requires an adequate record of the maxillary arch and cleft anatomy. However, impression making in infants presents distinctive challenges because of the small oral cavity, crying and movement, limited cooperation, cleft undercuts, and the potential for impression material to become displaced or retained [5,8,9,10,11].
This report describes the clinical challenges encountered during conventional alginate impression making and subsequent fabrication of a hard acrylic feeding obturator for a 6-month-old male infant with unrepaired complete right unilateral cleft lip and palate, together with short-term outcome at 2 weeks.
Case Presentation
A 6-month-old male infant was brought to Nishtar Institute of Dentistry, Multan, Pakistan, by his mother with the primary complaint of difficulty in feeding and drinking milk. Clinical examination revealed an unrepaired complete right unilateral cleft lip and palate. No surgical repair of the cleft lip or palate had been performed at the time of presentation.
On the basis of the feeding difficulty reported by the caregiver and the clinical findings, fabrication of a removable feeding obturator was planned as a supportive intervention before definitive surgical management. The procedure, anticipated challenges, appliance care, and follow-up requirements were explained to the mother. Written informed consent for treatment and publication of the anonymized case details was obtained from the infant’s mother.
Clinical Procedure
Impression Making
The impression-making stage represented the principal technical challenge. Because the infant was unable to sit independently in the dental chair, the mother was seated in the dental chair and held the infant securely on her lap during the procedure.
Before impression making, the cleft region was blocked out to minimize excessive penetration and possible entrapment of impression material within the defect. Alginate impression material was used to record the maxillary arch and palatal region. Care was taken to control the amount and distribution of material.
Obtaining a clinically acceptable impression was difficult because the infant cried extensively and moved during tray placement and impression making. The initial impressions were inadequate for appliance fabrication. Approximately four to five attempts were required before an impression considered clinically acceptable was obtained. After removal, the impression was examined for completeness, and the oral cavity and cleft region were inspected to ensure that no detached impression material remained intraorally.
Cast Preparation and Obturator Fabrication
The accepted alginate impression was poured to obtain a working cast of the maxillary arch and cleft region. A feeding obturator was fabricated using conventional hard acrylic resin. The appliance was designed to cover the palatal defect and create a more continuous palatal surface while avoiding unnecessary extension into the cleft and adjacent tissues.
After processing, the appliance was retrieved from the cast and carefully finished and polished. Particular attention was given to smoothing the borders and tissue-contacting surfaces to minimize the possibility of mucosal trauma. The completed obturator was evaluated intraorally for adaptation and stability, and necessary adjustments were performed before delivery.
Delivery and Caregiver Instructions
The feeding obturator was delivered after satisfactory clinical assessment. The mother was instructed regarding insertion and removal of the appliance, its use during feeding, cleaning, and oral hygiene. She was advised to inspect the oral tissues for irritation or ulceration and to return for clinical review if the appliance became unstable or if discomfort, mucosal injury, or feeding difficulty occurred. The need for follow-up was emphasized because continuing craniofacial growth during infancy can alter appliance fit over a short period.
Follow-Up and Outcome
The infant was reviewed exactly 2 weeks after delivery of the feeding obturator. According to the mother, the infant was able to drink milk more easily, nasal leakage of milk had decreased, and the time required for feeding had shortened compared with the period before appliance insertion. Clinical examination showed that the obturator remained stable, and no ulceration of the oral mucosa was observed.
No standardized measurement of feeding duration, milk volume, weight gain, or nutritional status was performed. Therefore, improvement in feeding efficiency and nasal leakage should be interpreted as short-term caregiver-reported outcomes rather than objectively quantified effects.
Timeline
| Clinical stage | Findings / intervention |
| Initial presentation | 6-month-old male infant with unrepaired complete right unilateral cleft lip and palate and difficulty feeding/drinking milk. |
| Treatment planning | Feeding obturator selected as a supportive feeding intervention. |
| Impression procedure | Mother supported the infant on her lap; cleft region blocked out; alginate impression attempted. |
| Impression challenge | Crying and movement resulted in inadequate initial impressions; approximately four to five attempts were required. |
| Definitive impression | Clinically acceptable maxillary impression obtained and inspected; oral cavity checked for retained material. |
| Laboratory stage | Working cast prepared; conventional hard acrylic resin feeding obturator fabricated, finished, and polished. |
| Delivery | Appliance adjusted and delivered; caregiver instructed regarding insertion, removal, feeding, hygiene, and review. |
| 2-week follow-up | Mother reported easier milk intake, reduced nasal leakage, and shorter feeding time; appliance stable; no oral ulceration observed. |
Discussion
Feeding is an immediate clinical concern in infants with cleft palate. Abnormal communication between the oral and nasal cavities may interfere with effective sucking and may contribute to prolonged feeding, nasal regurgitation, and difficulty achieving adequate intake [1,2,3]. Several feeding interventions have been described, including modified bottles and nipples, caregiver-assisted techniques, and prosthetic obturators [2,3,4,5,6,7]. A Cochrane review concluded that the available randomized evidence for feeding interventions in infants with cleft lip and/or palate is limited, supporting an individualized rather than universal approach to appliance use [2].
In selected patients, a feeding obturator can provide a firm palatal surface for nipple compression and reduce direct communication between the oral and nasal cavities during feeding [3,4,5,6,7]. The appliance is supportive rather than definitive and should be integrated with multidisciplinary cleft care. In the present case, the mother reported easier milk intake, reduced nasal leakage, and shorter feeding time over a 2-week period. Because these outcomes were not objectively quantified, they should be interpreted as caregiver observations rather than proof of treatment efficacy.
The most notable feature of this case was the difficulty of conventional impression making. Impression procedures in infants with cleft lip and palate are technically sensitive. Published reports emphasize careful control of material, appropriate positioning, assessment of the cleft anatomy and undercuts, and inspection of the oral cavity after impression removal [5,8,9,10,11]. A randomized clinical trial evaluating a specialized cleft impression tray also demonstrated that impression technique can influence procedure time, amount of material used, recording quality, and clinician anxiety [9].
Alginate was used in the present case. Although alginate is readily available and familiar to clinicians, its relatively limited tear strength is relevant when recording cleft undercuts, because fragments can theoretically tear or remain in the defect. Blocking out the cleft region before impression making and inspecting both the retrieved impression and oral cavity after removal were therefore important precautions in this case [5,8,10,11].
Patient positioning also deserves attention. The infant could not sit independently and was therefore supported by his mother on her lap. Similar caregiver-supported positioning has been described in infant cleft impression procedures [9]. However, no single position eliminates risk, and clinicians must remain attentive to airway protection and must be prepared to terminate the procedure if the infant shows signs of distress.
Approximately four to five attempts were required before an acceptable impression was obtained. This experience illustrates the practical tension between the need for a sufficiently accurate anatomical record and the need to minimize repeated manipulation in a distressed infant. Repeated attempts should not be pursued for unnecessary detail; an impression should be judged by whether it safely records the anatomy required for appliance fabrication. Alternative approaches described in the literature include custom or specialized impression trays, elastomeric materials, and digital workflows, depending on equipment, operator expertise, and infant anatomy [8,9,12].
The obturator in this case was fabricated from conventional hard acrylic resin. Acrylic resin provides a rigid, smooth, and polishable prosthesis, but careful finishing and intraoral adjustment are essential because rough or overextended surfaces may traumatize the delicate oral mucosa [4,5,6,7]. At the 2-week review, no ulceration was observed and the appliance remained stable. Continued review is nevertheless necessary because rapid maxillary growth can alter appliance fit and may require adjustment or replacement [5,8].
This case also highlights the central role of the caregiver. Safe use of a removable feeding appliance in an infant depends on caregiver understanding of insertion, removal, hygiene, feeding technique, observation for tissue irritation, and adherence to follow-up recommendations.
Strengths and Limitations
A strength of this report is its transparent description of the difficulty encountered during conventional impression making in a 6-month-old infant with complete cleft lip and palate. Reporting the unsuccessful initial attempts provides a realistic account of a clinically challenging procedure. The report also includes a defined 2-week clinical follow-up with caregiver-reported feeding outcomes, appliance stability, and examination for mucosal ulceration.
The principal limitations are the single-patient design, short follow-up period, absence of standardized pre- and post-treatment feeding measurements, and absence of clinical photographs. Feeding duration, milk volume, weight change, and nutritional parameters were not objectively recorded. Consequently, the report cannot establish comparative effectiveness or a causal treatment effect.
Caregiver Perspective
At the 2-week follow-up, the infant’s mother reported that milk feeding had become easier after delivery of the feeding obturator. She also observed less leakage of milk through the nose and a reduction in the time required to feed the infant.
Conclusions
Impression making for a feeding obturator in an infant with complete cleft lip and palate can be clinically challenging because of the small oral cavity, crying and movement, cleft anatomy, and potential risks associated with conventional impression materials. In this case, the cleft region was blocked out before impression making, and alginate was used to obtain a clinically acceptable maxillary impression after multiple attempts. A conventional hard acrylic resin feeding obturator was then fabricated and delivered.
At the 2-week follow-up, the caregiver reported easier milk intake, reduced nasal leakage, and shorter feeding time. The appliance remained stable, and no oral ulceration was identified. These findings support the potential usefulness of a feeding obturator as a short-term supportive intervention in an appropriately selected infant, while the subjective outcomes and limited follow-up preclude conclusions regarding long-term effectiveness. Careful impression procedures, caregiver education, regular clinical review, and multidisciplinary cleft management remain essential.
Ethics and Consent
This case report describes routine clinical care of a single patient. Written informed consent for treatment and for publication of the anonymized clinical details was obtained from the infant’s mother. No patient photographs or direct patient identifiers are included in this manuscript.
Author Contributions
Iqra Fatima: Conceptualization; lead clinical case management; data collection; literature review; original draft preparation; manuscript revision and editing; correspondence; and coordination of the final submission. Ujala Shahid: Clinical case management; data collection; literature review; and review and editing of the manuscript. Zara Farooq: Clinical case management; literature review; and review and editing of the manuscript. All authors reviewed and approved the final manuscript for submission.
Funding
The authors received no financial support or external funding for this case report.
Acknowledgments
The authors thank the infant’s mother for her cooperation during treatment and follow-up.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
References
- Mossey, P.A.; Little, J.; Munger, R.G.; Dixon, M.J.; Shaw, W.C. Cleft lip and palate. Lancet 2009, 374(9703), 1773–1785. [Google Scholar] [CrossRef]
- Bessell, A.; Hooper, L.; Shaw, W.C.; Reilly, S.; Reid, J.; Glenny, A.M. Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate. Cochrane Database Syst. Rev. 2011, (2), CD003315. [Google Scholar] [CrossRef]
- Goyal, M.; Chopra, R.; Bansal, K.; Marwaha, M. Role of obturators and other feeding interventions in patients with cleft lip and palate: a review. Eur. Arch. Paediatr. Dent. 2014, 15(1), 1–9. [Google Scholar] [CrossRef]
- Chandna, P.; Adlakha, V.K.; Singh, N. Feeding obturator appliance for an infant with cleft lip and palate. J. Indian Soc. Pedod. Prev. Dent. 2011, 29(1), 71–73. [Google Scholar] [CrossRef]
- Tirupathi, S.P.; Ragulakollu, R.; Reddy, V. Single-visit feeding obturator fabrication in infants with cleft lip and palate: a case series and narrative review of literature. Int. J. Clin. Pediatr. Dent. 2020, 13(2), 186–191. [Google Scholar] [CrossRef]
- Jones, J.E.; Henderson, L.; Avery, D.R. Use of a feeding obturator for infants with severe cleft lip and palate. Spec. Care Dent. 1982, 2(3), 116–120. [Google Scholar] [CrossRef]
- Goldberg, W.B.; Ferguson, F.S.; Miles, R.J. Successful use of a feeding obturator for an infant with a cleft palate. Spec. Care Dent. 1988, 8(2), 86–89. [Google Scholar] [CrossRef]
- Ravichandra, K.; Vijayaprasad, K.; Vasa, A.A.; et al. A new technique of impression making for an obturator in cleft lip and palate patient. J. Indian Soc. Pedod. Prev. Dent. 2010, 28(4), 311–314. [Google Scholar] [CrossRef]
- Kalaskar, R.; Bhaje, P.; Balasubramanian, S.; Kalaskar, A. Effectiveness of the novel impression tray “cleftray” for infants with cleft lip and palate: a randomized controlled clinical trial. J. Korean Assoc. Oral Maxillofac. Surg. 2021, 47(2), 82–90. [Google Scholar] [CrossRef]
- Chate, R.A.C. A report on the hazards encountered when taking neonatal cleft palate impressions (1983-1992). Br. J. Orthod. 1995, 22(4), 299–307. [Google Scholar] [CrossRef]
- Lipp, M.J. Lubitec: an impression procedure for the neonatal patient with a cleft palate. Spec. Care Dent. 1988, 8(5), 224–227. [Google Scholar] [CrossRef]
- Razek, M.K.A. Prosthetic feeding aids for infants with cleft lip and palate. J. Prosthet. Dent. 1980, 44(5), 556–561. [Google Scholar] [CrossRef]
- Pashayan, H.M.; McNab, M. Simplified method of feeding infants born with cleft palate with or without cleft lip. Am. J. Dis. Child 1979, 133(2), 145–147. [Google Scholar] [CrossRef]
- Gagnier, J.J.; Kienle, G.; Altman, D.G.; Moher, D.; Sox, H.; Riley, D.; CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. J. Med. Case Rep. 2013, 7, 223. [Google Scholar] [CrossRef]
- Riley, D.S.; Barber, M.S.; Kienle, G.S.; et al. CARE guidelines for case reports: explanation and elaboration document. J. Clin. Epidemiol. 2017, 89, 218–235. [Google Scholar] [CrossRef]
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