Design of a Novel Orthodontic Appliance to Prevent Pedicle Trauma in Patients Undergoing Double-Opposing Buccal Flaps for Palatal Lengthening

Objective: To describe a novel orthodontic appliance to prevent pedicle trauma in patients undergoing double-opposing buccal flap surgery for secondary palatal lengthening. Design: Case series. Setting: Cleft and craniofacial clinic, Johns Hopkins Children's Center. Patients, Participants: Four patients undergoing double-opposing buccal flap surgery for repair of velopharyngeal insufficiency. Interventions: Patients were fitted with the device, which consists of a lower lingual holding arch with acrylic bite blocks. Main Outcome Measure: Presence of pedicle trauma postsurgery and tolerability of the device. Results: The appliance was well tolerated in all 4 patients and no biting trauma to the pedicles was observed. Conclusions: A reliable appliance has been developed to prevent biting trauma to the pedicles in patients undergoing double-opposing buccal flap surgery in the permanent dentition stage.