PMC5299194_01
Extraoral views.
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Clinically, the patient exhibited multiple craniofacial anomalies, including a fissure on the upper part of the face, encephalocele, corneal opacity of the right eye, hypertelorism, severe hearing loss on the left side, and evident asymmetry (Figure 1).
(a) Right hand. (b) Right foot.
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The remainder of his body manifested constriction rings and anomalies in hands and feet (amputation and lymphedema) (Figure 2).
(a) Palate cleft view. (b) The obturator device (the hole was created to permit the recent eruption of the right central incisor). (c) Intraoral placement of the obturator.
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The intraoral clinical examination demonstrated a "Y"-shaped lip-palatal fissure from the soft palate terminating with a bifurcation in the upper lip and nose (Figure 3).
The patient's facial view, 10 months after the first examination.
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He showed a brachyfacial pattern and midface/maxillary arch hypoplasia (Figure 4) but a poor oral-hygiene level; the obturator had been properly used, and marked improvement in swallowing and feeding during the previous 3 months was manifested.
(a) Most recent view of the maxillary arch. (b) Adjustments made to the palatal obturator, according to the eruption process of primary teeth. (c) Palatal obturator well adapted in mouth.
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However, the device was not well adapted because the upper primary central incisors and first molars were in the eruption process; therefore, the corresponding acrylic trimmings were performed (Figure 5).