From Big Medical Encyclopedia

OBTURATORS (Latin obturare to lock, cork) — the prostheses intended for closing of defects of a hard and soft palate.

With defect (message) between an oral cavity and a nasal cavity, to-ry can be inborn or acquired (see. Sky ), breath is broken, the speech becomes nasal, muffled (see. Twang ), during the chewing and swallowing of food language does not find a support on the palatal arch, contents of an oral cavity get into a nasopharynx.

Palate defects are eliminated with an operational or orthopedic way. Patients use O. in cases when an operative measure is not shown or after operation will not achieve desirable result, and also between repeated operations. Prostheses obturators can serve not only for closing of palate defects, but also for substitution of an upper jaw, partially or completely resected concerning a new growth, after a gunshot wound and other damages. Lakes if necessary can be added with missing false teeth (see. Dentures ). Lakes are applied also to closing of inborn crevices of the sky at children in the presurgical period.

Applied in practice of O. to a hard palate are similar to basic plates of removable dentures. Usually they are attached to teeth by means of clasps or other devices and cover edges of defect. The nasal cavity at the same time remains free.

Lakes for a soft palate have more difficult device since they shall close defect of a palatine velum and change the situation at reduction of muscles of a soft palate, reaching at the same time a back wall of a throat.

At O.'s production use the plastic and other materials applied in the dentoprosthetic equipment.

Data on the first prostheses obturators belong to 16 century. In 1575 the fr. surgeon A. Paré suggested to close defect of a hard palate the gold plate connected to a piece of the sponge getting into a nasal cavity and called such prosthesis the obturator. In 1728 P. Foshar improved Paré's obturator, having replaced a sponge with the mobile «shoots» from ivory connecting to a palatal plate. Shoots entered into a nasal cavity vertically and by means of the screw moved to horizontal position thanks to what the palatal plate kept. Bourdet in 1796 created O. attached to teeth by a wire ligature. In 19 century in connection with emergence of the materials more convenient for processing (rubber, rubber, gutta-percha), possibilities of production of O. corresponding to a form of the sky and edges of defect considerably extended.

Fig. 1. Delabarr's obturator for closing of inborn crevices of a soft palate: 1 — a palatal plate; 2 — clasps; 3 — a metal plate for strengthening of an occlusive part; 4 — the hinge: 5 — an occlusive part for closing of defect of a soft palate.

The first O. for a soft palate was designed by De-labarre in 1820. It consisted of two parts: a palatal plate with two tape clasps, to-rye held it on teeth, and the occlusive part from soft rubber strengthened on a plate, edges connected to a palatal plate by means of the hinge (fig. 1). The offer of De-labarra made possible prosthetics at inborn crevices of a soft palate.

Lakes for a soft palate with mobile connection of parts were offered also to Kingsley (N. W. Kingsley, 1864), and afterwards by Shiltsky (O. Schiltsky, 1885), etc. Shiltsky's obturator represented a palatal plate with quite long, being on its rear edge spring, on the free end a cut an occlusive part from soft rubber was strengthened. The spring provided considerable mobility of an occlusive part and reduced the loading falling on muscles of a soft palate.

Broad application of O. with mobile connection of parts was not found since the movements of an occlusive part did not correspond to the speed of reduction of a soft palate, muscles of the sky leaky pressed down an occlusive part to a wall of a throat owing to what the nasal shade of the speech was not eliminated; thin details (springs, hinges, rings) were fragile, and soft rubber lost the elasticity over time.

Fig. 2. The diagrammatic representation of plaster model of an upper wall of an oral cavity with the «floating» obturator of Keyz: 1 — a hard palate; 2 — the split soft palate; 3 — the oral part of the obturator covering edges of a crevice of a hard and soft palate; 4 — a nasal part of the obturator (is shaded).

In 1867 Syursenom (F. - W. Suersen) made inelastic O. for a soft palate, to-ry was applied in cases when muscles of a soft palate did not function (rubtsovo were changed) or were absent. An occlusive part of a prosthesis filled a nasopharynx, leaving a choke for air at breath. At reduction of muscles of a pharyngeal ring pass for an air stream was closed at the expense of the so-called muscular roller of Passavan which is formed on a back wall of a throat that created satisfactory conditions for swallowing and pronouncing sounds of the speech. In the subsequent I. I. Hrushchov (1884) offered two O. of this kind: one rigid, and another with the pneumatic cylinder from soft rubber getting into a nasal cavity. These O.' lack is their bulkiness, excessively big contact surface with a mucous membrane of a nasopharynx. However the principle of fixing of O. at the expense of its dense prileganiye to the muscular ring formed by edges of a crevice of a soft palate and muscles of a throat was successfully used by Keyz (Page S. Case) which offered the besklammerny O. which received the name of «floating» (fig. 2) in 1902.

In the USSR this O. was implemented in practice 3. I. Chasovskoy (1957, 1972) after considerable simplification and improvement of a technique of its production. This O. is applied to continuous use at an inborn crevice of the sky at children, since first days of life.

Fig. 3. The children's obturator of Ilyina-Markosyan for continuous use (and — a view from side of the sky — a lateral view): 1 — a palatal plate from hard plastics; 2 — clasps; 3 — the lower leaf of a palatine velum (from elastic plastic); 4 — an upper mobile leaf of a palatine velum; 5 — the button connecting both leaves of a palatine velum.

In 1951 the children's O. for continuous use since 2,5 — 3 years attached by means of clasps or other devices to the available teeth was offered L. V. Ilyina-Markosyan. It represents a palatal plate from hard plastics with an elastic palatine velum, edges consists of two leaves connected by a metal button (fig. 3). The lower leaf is direct continuation of a palatal plate and covers a crevice of a back third of a hard palate. The upper leaf covers a crevice of a soft palate from a nasal cavity and at reduction of muscles of a soft palate and a throat reaches its back wall.

This O. can serve as at the same time orthodontic device: it is possible to add false teeth, various devices for its fixing and active orthodontic elements to a palatal plate (basis) — repellent levers, the pro-traction (putting-forward) or rukoobrazny springs, re traction arches, etc. (see. Orthodontic methods of treatment ).

The described children's O. are applied in complex treatment of children with an inborn crevice of the sky before performing operational treatment by it. Early use of O. facilitates food, normalizes breath, helps to seize the speech, creating conditions for the correct pronouncing sounds of the speech.

Fig. 4. The obturator to Varnekroza for artificial feeding of children of chest age: 1 — a small bottle with milk; 2 — a rubber pacifier; 3 — a disk with openings for a core of the obturator; 4 — a palatal plate obturator; 5 — a metal core for strengthening of the obturator.

Plates obturators for newborns with a crevice of the sky were offered, to-rye apply only during feeding of the child. To Varnekroza (To. Warnekrose, 1895) offered the palatal plate from soft rubber strengthened by means of a metal core on a celluloid disk, to-ry put on a small bottle with a pacifier (fig. 4). Open-hearth furnace (To. Martin, 1905) adapted such plate for feeding of the child a breast, having added it with two springing levers with olives from soft rubber on the free ends. Olives entered into a nasal cavity (through nostrils) for the purpose of fixing of a palatal plate during the act of suction.

P. S. Parchment (1938) applied a rubber plate with the pneumatic cylinder filling a cavity of defect; this O. was attached to a rubber semicircle with an opening for a nipple of mother. The occlusive plate from elastic plastic for closing of defect of a hard and soft palate was offered L. V. Ilyina-Markosyan (1951), edges it is attached to a small bottle by means of silk thread.

The lack of plates obturators is that out of the period of feeding the child remains without O. and an oral cavity and a nose are reported among themselves; it adversely affects the general development of the child, formation of dentitions and mastering by it informal conversation.

Instruction for use and care of the obturator. After O.'s fixing in an oral cavity there comes the period of adaptation, to-ry proceeds from several hours to several days. At first O. causes the increased salivation, nausea and other unpleasant feelings; despite it, it is necessary to use it constantly, without removing during the conversation and meal. Gradually unpleasant phenomena pass, the pronunciation considerably improves, process of chewing and swallowing is facilitated.

After O.'s food it is necessary to wash out in a cup warm water with soap, by means of a toothbrush. For the night it needs to be removed and stored in the closed cup, previously and having wiped washout dry. Children shall remove O. for the night. If O. causes inconveniences or pain, it is necessary to see a doctor for correction of the Lake.

Bibliography: Betelman A. I. Orthopedic stomatology, page 381, M., 1965; Vasilyev M. E., etc. Dentoprosthetic equipment, page 422, M., 1958; Or i-na-Markosyan L. V. Orthopedic treatment of children at inborn crevices of the sky, Stomatology, No. 4, page 61, 1958; H and with about in with to and I 3. I. Metodika of production of the floating obturator, in the same place, No. 2, page 62, 1957; it, Use of obturators at inborn crevices of the sky, D., 1972; D about of and p-with e G. M of The operative story of cleft palate, Philadelphia, 1933.

L. V. Ilyina-Markosyan.