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 improveThe 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
*References
* Borzabadi-Farahani, A., Groper, J.N., Tanner, A.M., Urata, M.M., Panossian, A., & Yen, S.L. (2012). The Nance Obturator, a New Fixed Obturator for Patients with Cleft Palate and Fistula. Journal of Prosthodontics,21(5):400–403. * Kuehn, D.P., & Moller, K.T. (2000).Speech and Language Issues in the Cleft PalatePopulation: The State of the Art. The Cleft Palate-Craniofacial Journal, 37, 348–348. * Marino, V.C.C., Williams, W.N., Wharton, P.W., Paulk, M.F., Dutka-Souza, J.C.R.,& Schulz, G.M. (2005). Immediate and Sustained Changes in Tongue Movement With an Experimental *Palatal “Fistula”: A Case Study. The Cleft Palate-Craniofacial Journal, 42, 286–296. * "Maxillofacial Prosthetics." Rhode Island Department of Human Services. Rhode Island Department of Human Services. 10 July 2006