Neonatal palatal appliance: light-cured resin material and flexible design.

In premature neonates, with birth weights between 550 and 1250 g, short-term orotracheal intubation is routine. Despite the use of surfactant and steroids, 20% of these premature neonates develop pulmonary dysplasia, which requires an unpredictable ventilation period with an orotracheal tube.' 2 Placement of the orotracheal tube may extend from hours to months, and may result in midface changes. Long-term palate deformation, hypoplastic enamel, and speech incompetency have been documented in 3to 5and 7to 10year-oldsA 6 In 1984, Erenberg and Nowak described a palatal appliance for use in premature neonates/ Their design, which was similar to that described by Sullivan in 1981, has been adopted by a number of major children's hospitals to prevent palatal groove. Medical,^ dental, ̂ and respiratory therapy literature have described its use. The purpose of this article is to describe a 22-month experience with 76 premature neonates using a new palatal appliance design. This appliance, constructed with visible light-cured urethane, is placed and removed easily. Its chief advantages lie in the properties of visible light-cured urethane, its design (which engages any size orotracheal tube), and its requirement for limited maintenance by the nurse or care provider. The appliance consists of light-cured pink denture base resin (Triad®, Dentsply Co., York, PA), one 0.032in. stainless steel ball-clasp wire (3M-Unitek Co., Monrovia, CA), a closed-link synthetic elastic latex polymer chain (3M-Unitek Co.), and a 10-cm piece of dental floss (Johnson and Johnson Co., New Brunswick, NJFig 1 and 2). After blending the two components of a vinyl impression putty (Express STD®, 3M-Unitek Co.) for 20 sec, the putty is introduced to the palate with a suitable tray and held for 30 sec to produce an accurate impression. A model is made and is marked in the following areas: along the midsagittal suture to the labial sulcus; at both lateral sulci, 1 mm labial to the crest of the posterior alveolar ridge, on the anterior alveolar crest between the lateral sulcus, and at the hard palate junction with the soft palate (Fig 3, next page). A small sheet of 2-mm thick urethane is placed upon the model and trimmed with a No. 15 scalpel blade to the established lines drawn on the model's alveolar ridge and posterior palate. The ball-clasp wire is bent at a distance of 4 mm from its ball end, to 30° (bend #1, Fig 4, next page). A 90° bend (bend #2) is made 6 mm from the first. Another 90° bend (bend #3) is made 1 cm from the first. The wire between these 90° bends will be retained in the urethane. At 4 mm from the last bend, the wire is looped upon itself (bend #4), and the excess is cut. A closed-four-link latex chain is secured to this loop of wire, and a colored piece of dental floss is attached to the wire and latex chain link. The floss is knotted every 2 cm along its length, then the third link of the latex chain is placed on the ball clasp with very slight tension.