title: A novel patient-controlled bidirectional palatal lift appliance.
abstract: OBJECTIVE
  Palatal lift appliances have a role in management of velopharyngeal dysfunction for immobile palates of adequate length where surgery is contraindicated. Conventional appliances involve acrylic/wire work adjustment over successive appointments until they can be tolerated without gagging. A novel appliance has been developed where the lifting plate is incrementally distalized by the patient and vertically adjusted to optimize soft palate positioning.
  
  
  METHODS
  The design, construction, and utility of the appliance, which was developed in Dundee Dental Hospital, are described.
  
  
  METHODS
  The subject was a 12-year-old boy with a variant of Moebius syndrome and velopharyngeal dysfunction. Previous pharyngoplasty had been carried out and further surgery was contraindicated.
  
  
  METHODS
  The appliance is constructed and fitted and the flexible spring arm is vertically adjusted to lift the soft palate. The screw is turned incrementally at home, extending the lifting plate posteriorly. Videofluoroscopy allows visualization of the appliance and soft palate positioning.
  
  
  RESULTS
  The procedure improved soft palate positioning, as demonstrated by videofluoroscopy, and objective speech outcomes.
  
  
  CONCLUSIONS
  The appliance was well tolerated and led to improved speech outcomes for the patient. Adjustments were quick and easy for both clinician and patient. Further studies are needed to definitively determine the efficacy of the appliance.
authors.forename: L E
authors.initials: LE
authors.lastname: Greene
authors.forename: K
authors.initials: K
authors.lastname: Wilson
authors.forename: G
authors.initials: G
authors.lastname: McIntyre
authors.forename: J
authors.initials: J
authors.lastname: Wilson
authors.forename: F V
authors.initials: FV
authors.lastname: Mehendale
mesh_terms: D002648:Child; D002972:Cleft Palate / Q000628:therapy*; D006801:Humans; D008297:Male; D020331:Mobius Syndrome / Q000601:surgery / Q000628:therapy*; D010160:Palate, Soft; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019233:Retreatment; D013068:Speech Production Measurement; D014681:Velopharyngeal Insufficiency / Q000601:surgery / Q000628:therapy*
keywords: burden of care; palatal lift; patient-controlled appliance; speech appliance; velopharyngeal dysfunction; videofluoroscopy