Palatal lift prosthesis information

A palatal lift prosthesis is a prosthesis that addresses a condition referred to as palatopharyngeal incompetence. Palatopharyngeal incompetence broadly refers to a muscular inability to sufficiently close the port between the nasopharynx and oropharynx during speech and/or swallowing. An inability to adequately close the palatopharyngeal port during speech results in hypernasalance that, depending upon its severity, can render speakers difficult to understand or unintelligible.^[1] The potential for compromised intelligibility secondary to hypernasalance is underscored when consideration is given to the fact that only three English language phonemes – /m/, /n/, and /ng/ – are pronounced with an open palatopharyngeal port.^[2] Furthermore, an impaired ability to effect a closure of the palatopharyngeal port while swallowing can result in the nasopharyngeal regurgitation of liquid or solid boluses.

Palatopharyngeal incompetence should not be confused with palatopharyngeal insufficiency. While palatopharyngeal incompetence and palatopharyngeal insufficiency contribute to similar symptomatology as they relate to speech and swallowing, the former results from a hypomobility or paralysis of intact anatomy that is normally responsible for effecting palatopharyngeal closure while the latter results from a congenital or acquired absence of that anatomy. Palatal lift prostheses are designed to address palatopharyngeal incompetence. Although structurally similar to palatal lift prostheses, technically distinct soft palatal obturator prostheses or speech aid prostheses are used to address palatopharyngeal insufficiency.

A palatal lift prosthesis addresses palatopharyngeal incompetence by physically displacing the dysfunctional soft palate in the hope of closing the palatopharyngeal port enough to mitigate hypernasal speech and/or prevent nasopharyngeal regurgitation of liquids or solids during the pharyngeal phase of swallowing. A palatal lift prosthesis consists of an oral component that stabilizes and secures the prosthesis and an oropharyngeal extension that superiorly and posteriorly displaces the impaired soft palate. Palatal lift prostheses are classified as interim or definitive prostheses.^[3]

Interim palatal lift prosthesis consisting of polymethylmethacrylate and orthodontic wire clasps

Cast metallic palatal lift prosthesis framework and the master cast upon which it was constructed prior to the addition of the polymethylmethacrylate responsible for elevating the soft palate.

Cast metallic palatal lift prosthesis following the addition of the polymethylmethacrylate responsible for elevating the soft palate.

An interim palatal lift prosthesis generally consists of two or more stainless steel wire retentive clasps embedded in polymethylmethacrylate that adapts to the hard palatal and soft palatal mucosal surfaces and the lingual aspects of the maxillary teeth. An interim palatal lift prosthesis carries a current dental terminology code number of D5958. A definitive palatal lift prosthesis generally consists of a thin cast metallic alloy lamina that covers the hard palatal mucosa and the lingual aspects of the maxillary teeth and incorporates retentive clasps that strategically engage undercut dental surfaces to enhance the retentive capacity of the prosthesis. The cast metallic portion of a definitive palatal lift prosthesis typically harbors a posterior cast metal lattice that retains a polymethylmethacrylate oropharyngeal section of the prosthesis responsible for elevating the soft palate. A definitive palatal lift prosthesis carries a current dental terminology code number of D5955. Definitive and interim palatal lift prostheses both carry current procedural terminology code numbers of 21083.