Latham Appliance in Infants with Unilateral Complete Cleft Lip and Palate

by Elizabeth I. Ross, DDS

In the past six months, two important studies have been published from the Department of Dentistry at Boston Children’s Hospital (BCH) that show the outcome of using the Latham appliance in infants with unilateral complete cleft lip and palate.

The Latham appliance is a pre-surgical orthodontic device that is utilized to help decrease the width of the cleft prior to plastic surgical intervention. Typically the appliance is inserted within the first three months of life and is in place until the initial lip surgery. The appliance is custom made from an impression taken by your treating dentist. Both parents and the dentist will be involved in activating the appliance to facilitate closure of the cleft over a five-week interval.

Leo is one of our recent Latham graduates. Above, he is pictured prior to the Latham appliance insertion.

Five weeks later, Leo mets with his team at Boston Children’s Hospital prior to removal of the device.

The dental department at Boston Children’s Hospital has been using the Latham device successfully for infants with cleft lip and palate since 1997. Dr. Stephen Shusterman pioneered this technique at Boston Children’s after studying directly with Dr. Latham. Skeptics of the Latham appliance claim that it is a painful procedure for an infant to endure. The efficacy of correction with this device has also been questioned, as there are other appliances available which are less invasive. The two publications below refute the comments above and we are very proud that our recent orthodontic cleft and craniofacial fellows contributed to the literature.

Adele Bronkhorst was a recent graduate from the orthodontic cleft and craniofacial fellowship at BCH. She graduated in 2012 and currently works overseas in Dubai as an orthodontist with specialty training in cleft lip and palate. Bronkurst and her colleagues1 in the dentistry department assessed the morbidity associated with application of the Latham appliance in infants. They studied 109 infants with unilateral and bilateral complete cleft lip and palates who underwent Latham appliance insertion. Pain and discomfort were measured via vital signs and the standardized FLACC score (Face, Legs, Activity, Cry, Consolability). In this study patients were found to have a minimal change in FLACC scores initially post insertion, with return to normal scores by three hours. This data suggests that infants do not experience significant pain after Latham insertion and likely some of the alterations in FLACC scores can be attributed to irritability due to the size and location of the appliance.

Not to be outdone, Sath Allareddy, the orthodontic cleft and craniofacial fellow from 2013, who also holds an MBA, PhD and a Masters of Medical Science, recently published an article examining the post-operative effects of Latham appliance insertion. Allareddy and Boston Children’s Dentists/Orthodontists2 investigated 40 infants who had Latham application in the setting of a unilateral complete cleft lip and palate. Alareddy found that the application of the Latham device was associated with significant reduction in the width of the cleft and the outcomes were predictable without any major adverse events or complications.

These two articles clearly demonstrate the positive benefits associated with Latham application in the pre-surgical treatment for infants with unilateral and bilateral complete cleft lip and palates. We are fortunate at Boston Children’s to be one of the leading centers that can offer this treatment to our patients affected by cleft lip and palate and we believe that it positively affects the outcome after plastic surgery.

1 Bronkhorst et al. Assessment of morbidity following insertion of fixed preoperative orthopedic appliance in infants with complete cleft lip and palate. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Mar 119(3): 278-284.

2 Veerasathpurush Allareddy et al. Operative and Immediate Postoperative Outcomes of Using a Latham-Type Dentomaxillary Appliance in Patients With Unilateral Complete Cleft Lip and Palate. Cleft Palate Craniofac J. 2014 Jul 24 [Epub].